KUALA LUMPUR, Oct 24 — The National Cancer Society of Malaysia (NCSM) has voiced serious concern over insurance denials and delays in cancer care, saying such issues have long affected cancer patients and are now being brought into sharper focus through CodeBlue’s nationwide specialist survey.
NCSM managing director Assoc Prof Dr M. Murallitharan, a public health physician, said the patient advocacy organisation has for years received reports of cancer patients being denied coverage for critical treatments or facing long delays in obtaining insurer approval for their therapy.
“Clinical needs of patients come first. There is no question on this,” Dr Murallitharan told CodeBlue yesterday.
“Ironically, we have, for years, been advocating on how such actions have been going on — it’s good that now it has been mainstreamed enough. For years, patients have reported being subject to issues of being denied certain treatments and not provided with coverage when needed.”
Dr Murallitharan was responding to findings from CodeBlue’s recent survey of 855 private hospital specialists, which found that oncologists were among those most affected by insurer interference, including denials of outpatient therapy like radiotherapy and drug claims for targeted therapy or biologics.
He said these patterns were consistent with NCSM’s long-standing experience assisting patients who find themselves caught between clinical recommendations and insurance restrictions.
“When they are buying an insurance policy, especially medical insurance, they are often told that it is there to cover your medical expenses. However, it’s not always the case — some hospitals can’t use a particular insurance, or even in some cases, some doctors are not covered by a certain insurer. These are some of the problems which additionally impact a patient already hit with a cancer diagnosis,” Dr Murallitharan said.
He added that such coverage gaps not only limit patients’ choice of doctor and hospital, but also delay timely treatment, undermining patient outcomes and continuity of care.
Patients’ Viewpoint: Insurance Exclusions A ‘Slow Death Sentence’
In earlier advocacy materials, NCD Malaysia – a coalition led by NCSM that represents Malaysians living with non-communicable diseases (NCDs) such as cancer, diabetes, and heart disease – described how insurance exclusions and premium loading for people with pre-existing conditions amount to what it calls a “slow death sentence”.
The coalition said patients are routinely denied coverage, excluded from claims, or charged higher premiums because of their medical histories.
These practices, NCD Malaysia argued, penalise people for conditions beyond their control, forcing them to shoulder the financial burden of chronic illness throughout their lives.
The group highlighted how such exclusions place patients under constant financial risk, depriving them of access to high-quality or innovative treatments available only in private care.
One example cited was a psoriasis patient who could not obtain coverage for her condition and was therefore limited to public-sector treatment, where access to newer drugs was constrained.
NCD Malaysia described these exclusions as discriminatory, noting that they effectively punish people for medical conditions beyond their control.
“Punishing someone for their pre-existing condition is discrimination,” the coalition wrote, calling for Malaysia to follow countries like the United States, where the Patient Protection and Affordable Care Act (ACA) prohibits insurers from denying coverage or charging higher premiums due to pre-existing conditions.
In response to persistent gaps in protection for cancer patients, NCSM has begun developing its own micro-insurance initiatives to provide targeted financial coverage.
Earlier this month, the organisation launched LungShield, a micro-insurance plan for lung cancer screening, in collaboration with its insurance partner, MCIS Life, as part of its broader effort to make early detection more affordable and accessible.
The plan offers low-cost coverage for lung cancer screening, helping Malaysians detect the disease earlier and improve survival outcomes.
Insurance Gaps Amplify Financial Catastrophe Of Cancer
Dr Murallitharan emphasised that cancer patients are among those most vulnerable to financial hardship from denials and delays, since cancer is both a leading cause of catastrophic health expenditure and a major reason people purchase private medical insurance in the first place.
“As you well know, screening and diagnosis itself is already going to come up into the tens of thousands, and this is already a pocket not covered by insurance — only if positive can pay and claim,” Dr Murallitharan said.
Most medical insurance policies do not cover cancer screening or diagnostic tests, even though the Malaysia National Cancer Registry Report 2017-2021 shows that the proportion of cancers detected at Stage 3 and 4 has increased to 65.1 per cent from 63.7 per cent in the 2012-2016 period – indicating that many cases are still found only when advanced.
A plastic and reconstructive surgeon in Sabah, quoted in CodeBlue’s survey, illustrated how such coverage limitations can affect real patients: “Had a doctor who came to see me with a bad cancer of the foot. Early stage. However, this type of cancer carried a grave prognosis. Approval was denied, stating a wide excision was ‘not medically indicated’.”
Dr Murallitharan said this kind of denial underscores the urgent need for insurers to align coverage decisions with clinical guidelines, rather than administrative classifications or narrow benefit interpretations.
He added that treatment itself often exposes patients to another layer of uncertainty, as older insurance policies offer limited reimbursement values, while many new cancer treatments, such as immunotherapy or next-generation targeted drugs, remain uncovered.
“Treatment is a whole other set of concerns. Some people are not covered adequately, with older insurance policies having small reimbursement values; and many new treatments remaining uncovered.
“In general, the insurance sector has to move to incorporate more adherence to clinical treatment pathways and guidelines on how various conditions are being treated, as well as to be transparent on what they are covering (and what they are not). Only then patients can make better choices in terms of obtaining coverage — or foregoing it altogether.”
Dr Murallitharan’s comments come after Beacon Hospital medical director Dr Mohamed Ibrahim Abdul Wahid warned earlier this week that insurance interference in cancer care was endangering patients’ lives, particularly through denials of standard-of-care drugs like Herceptin and gemcitabine.
Dr Mohamed Ibrahim told CodeBlue that some insurers have withdrawn cashless facilities from doctors or hospitals that refused to provide steep discounts – in some cases, up to 30 per cent – demanded by insurance panels. Such practices, he said, were “putting patients’ lives at risk”.
CodeBlue’s nationwide survey of 855 private hospital specialists, released in a full 200-page report this week, found that 99 per cent of respondents perceived insurer interference in their clinical decision-making.
Among oncologists, many reported denials of radiotherapy – on the basis that it is “outpatient” care – as well as refusals to cover cancer drugs, particularly newer targeted therapies and biologics.
Several doctors said insurers routinely reject claims for cancer treatment until multiple rounds of paperwork and “clarifications” are submitted, delaying therapy for patients in critical windows of care.
