KUALA LUMPUR, Oct 16 — Bayan Baru MP Sim Tze Tzin warned insurance companies today that interference with doctors’ clinical decision-making and “Deny, Delay, Revoke” practices may be unlawful.
Describing the findings of a recent CodeBlue survey among 855 private specialists as “rather shocking”, the PKR lawmaker pointed out that 99 per cent of respondents perceived insurer interference with their clinical decisions.
“Most patients bought insurance policies since they were young and have been loyally paying premiums. But insurance fails to protect them at a time when they most need protection,” Sim said when debating the motion of thanks on Budget 2026 in the Dewan Rakyat.
“Enough is enough.
“Insurance companies that interfere with clinical decisions, deny or delay guarantee letters (GL), or revoke treatment approvals may be breaking the law.”
The Pakatan Harapan (PH) MP cited Health director-general Dr Mahathar Abd Wahab’s recent statement that Section 82 and Section 83 of the Private Healthcare Facilities and Services Act 1998 (Act 586) set out “clear principles and statutory safeguards” to protect clinical decision-making from “undue influence”.
Sim noted that more than 650 specialist doctors participating in CodeBlue’s poll offered examples of health insurance companies or third-party administrators (TPAs) intruding into their practice of medicine, such as denials of coverage for various diagnostic tests, admission, procedures, and drugs or therapies for their patients.
He cited an example in CodeBlue’s survey of a seven-year-old patient with severe epigastric pain for a week, whose insurer denied the treating physician’s request for an endoscopy because the child needed to have symptoms for a month to qualify.
“This is very sad,” said Sim.
According to CodeBlue’s survey, 80 per cent of respondents reported that their patients faced delayed approvals of guarantee letters (GL) or claims over the past year. About 67 per cent have experienced cases of GLs being revoked for their patients after admission or treatment.
Sim cited an example of a patient admitted for emergency surgery following a road traffic accident, whose “initial” GL was revoked due to undisclosed “pre-existing conditions” and was eventually transferred to a government hospital. The case quoted in CodeBlue’s poll had incidental findings of high random blood sugar and sinusitis.
He cited another anecdote from the survey of a heart attack patient in Johor, whose GL was delayed by insurance. Despite a cardiologist’s advice to proceed with treatment immediately, the patient refused due to fears of a large bill and subsequently suffered more cardiac injury.
“A few other doctors reported that their patients suffered prolonged illness as a result of GL delays; some even died,” said Sim.
The government backbencher stressed that no one wants to fall ill or get into an accident.
“But when they face insurance giants with formidable legal teams, they’re unable to defend themselves. Many just keep quiet and are scared, disappointed, or have given up,” said Sim.
“We Members of Parliament must fight for justice for them.”
Sim, who has been championing the issue of health insurance premium hikes since last year, called for the formation of a national taskforce comprising the Ministry of Health (MOH), Bank Negara Malaysia (BNM), and the Royal Malaysia Police (PDRM) to investigate all the cases reported by specialists in CodeBlue’s survey.
[Editor’s note: CodeBlue’s poll was anonymous].
The Bayan Baru MP further called for an independent Private Health Care Commission to regulate the private health care sector, saying that the current Joint Ministerial Committee on Private Healthcare Costs (JMCPHC) is “temporary in nature.”
JMCPHC, co-chaired by Finance Minister II Amir Hamzah Azizan and Health Minister Dzulkefly Ahmad, isn’t a statutory commission.
“Structural problems need to be addressed, so a Private Health Care Commission can help,” said Sim.
Following the publication of CodeBlue’s nationwide survey among over 850 specialists on health insurance problems, the Galen Centre for Health and Social Policy yesterday called for the establishment of an independent statutory Private Health Care Commission to regulate private hospital charges and private medical and health insurance/takaful (MHIT) products.
