KUALA LUMPUR, Oct 24 — MCA has called for the enactment of legislation to protect patients and policyholders from denials and delays of care by insurers and takaful operators (ITOs) and third-party administrators (TPAs).
MCA president Wee Ka Siong said the “deny, delay, revoke” insurance tactics highlighted in CodeBlue’s nationwide survey among more than 850 private specialists showed how patients were left without protection when they needed it most.
“Malaysia needs clear laws to prohibit such discrimination and protect policyholders from arbitrary exclusions,” Wee, who is also Ayer Hitam MP and former transport minister, told CodeBlue in a statement yesterday.
“MCA supports introducing provisions to protect patients’ rights in private health insurance to ensure fairness, transparency, and accountability. Health insurance is not a luxury product; it is purchased as a promise of care when Malaysians fall ill.”
The Barisan Nasional (BN) lawmaker stressed that patients should not be denied treatment or forced to pay higher premiums due to pre-existing or incidental conditions.
Many doctors polled by CodeBlue complained about insurers denying coverage or revoking guarantee letters (GLs) due to patients’ pre-existing conditions, most commonly diabetes, even though these chronic diseases were unrelated to the admission diagnosis (for example, dengue, pneumonia, or fracture) or an incidental finding.
While the United States’ Patient Protection and Affordable Care Act (ACA) prohibits insurers from denying coverage or charging higher premiums due to pre-existing conditions, Malaysia has no such law for ITOs or TPAs that remain largely unregulated.
Wee’s statement follows similar criticisms by Bayan Baru MP Sim Tze Tzin from PKR and Bandar Kuching MP Dr Kelvin Yii from DAP towards the insurance/takaful industry, illustrating cross-party demand for clearer regulatory frameworks for patient protection in health insurance.
The MCA president also backed calls for the establishment of an independent statutory body to regulate both private health insurers and health care providers.
“Patients today are caught in a system where Bank Negara focuses on industry supervision, while the Health Ministry is already overstretched as a service provider. Neither is in a position to protect patients or doctors from insurer interference,” said Wee.
“A neutral and independent Private Health Care Commission, empowered by Parliament, can close this gap and its role should be to safeguard patient rights, prevent insurers from overruling clinical decisions, and ensure timely approvals and fair coverage.
“Malaysians deserve the same level of protection in health insurance as those that depositors enjoy in the financial sector.”
CodeBlue’s poll of 855 specialist doctors across specialties found that 99 per cent perceived ITO or TPA interference with their clinical-decision making, which Wee described as signalling a “serious failure in the administration and governance of private health care and insurance”. Overall findings, he said, were “deeply alarming”.
A joint statement by the Life Insurance Association of Malaysia (LIAM), the Malaysian Takaful Association (MTA), and the General Insurance Association of Malaysia (PIAM) yesterday did not address health care providers’ allegations of payer interference with the practice of medicine.
The insurance/takaful industry merely touted an average 90 per cent medical claims approval rate, without providing statistics on the rate of GL denials or revocation.
About 73 per cent of respondents in CodeBlue’s poll said their patients were referred to public hospitals due to insurance denials or delays; only 4 per cent said patients could afford going without cashless access by paying first and claiming later.
“Patients who have paid faithfully for years are still facing denial, delay or outright revocation of coverage when they need treatment most,” said Wee.
“This reflects a structural breakdown where profit has overtaken patient welfare. As a result, many M40 patients are being pushed back into public hospitals, adding to an already overburdened system that is struggling from years of mismanagement.”
The Ayer Hitam MP, however, also cited “rogue practices among a small minority of clinicians” who overcharge, overprescribe, or attempt to “tweak” medical reports to fit insurance claim criteria.
“Accountability must cut both ways,” he said.
In some cases, Wee said, insurance agents themselves are “complicit” in such practices, citing a recent controversy involving Lasik procedures disguised as cataract treatments.
“However, insurers cannot use such abuses as a blanket justification to deny legitimate claims or interfere arbitrarily with medical decisions,” said Wee.
“They are equally accountable for maintaining ethical standards and fair treatment. What Malaysia needs is a balanced system of checks and safeguards that protects patients without penalising honest doctors.”
The MCA president touted independent medical review boards, transparent fee schedules, and audit trails to strengthen oversight “on both sides”.
“The goal must be to restore trust and fairness in our health care system. Ultimately, clinical decisions should rest with qualified doctors guided by evidence and patient welfare.”
CodeBlue has released a 200-page report containing the full anonymised responses in its health insurance survey.
