PETALING JAYA: The Malaysian Medical Association (MMA) has urged Bank Negara Malaysia (BNM) to disclose what protection is available to patients affected by insurance companies’ withdrawal of cashless facilities for private specialists.
In a statement, MMA president Dr Sivanaesan Letchumanan also called on the central bank to reveal the number of complaints received over cashless restrictions, panel withdrawals and demands for doctors to return payments, as well as how many cases were resolved.
The MMA’s call follows revelations during the 2027 budget debate in the Dewan Rakyat that about 190 private sector specialist doctors nationwide had reportedly lost their cashless facilities with insurance companies.
Cashless facilities allow insured patients to receive treatment without paying upfront, with the insurer settling the approved medical bill directly with the healthcare provider.
“Healthcare in this country is increasingly being controlled by ‘commercial interests’ rather than guided by clinical judgment and the needs of patients,” he said.
“Malaysians pay their medical insurance premiums every month in good faith. They expect to be covered when they fall ill. Instead, a growing number are told that their chosen specialists have been removed from a panel or restricted from cashless admission.
“They are then forced to change doctors, move hospitals or pay tens of thousands of ringgit upfront. In emergencies, such delays can put lives at risk. Patients must never become collateral damage in commercial disputes involving insurers, hospitals and doctors.”
Sivanaesan called on BNM to establish a transparent framework governing insurers’ decisions to restrict doctors’ cashless facilities and remove doctors from panels.
The framework should require insurers to provide written reasons and evidence for their decisions, allow doctors to respond and rectify shortcomings, and establish a clear appeal process, he said.
Insurers requiring specialists to work for 1 year before treating insured patients
Sivanaesan also expressed concern over reports that some insurers required newly appointed specialists to work at a private hospital for a year before they could treat insured patients.
He said specialists had already undergone training and received recognition from the relevant authorities.
“It is not the role of an insurance company to override that recognition,” he said.
“When commercial entities decide who may practise and on whom, the doctor-patient relationship is undermined and medicine becomes subordinate to the balance sheet.”
Sivanaesan raised concerns about retrospective audits and clawbacks, in which insurers seek to recover payments for completed cases, sometimes over documentation, coding or administrative issues.
Such actions were often taken without written explanations, supporting evidence or a fair opportunity for doctors to respond, he said.
Sivanaesan urged the health ministry to review and update procedure coding and the medical fee schedule — which he said was a frequent source of disputes — to reflect current clinical practices and technological advances.
He also called for safeguards to ensure patients’ treatment continued uninterrupted while disputes involving insurers, hospitals and doctors were being resolved.
Sivanaesan warned that unchecked restrictions could push more patients towards already overburdened government hospitals and weaken the healthcare system.
“Health insurance exists to protect patients, not to obstruct their treatment,” he said, calling for meaningful engagement among all stakeholders and greater patient involvement in decisions affecting their care.