KUALA LUMPUR, Oct 2 — MediExpress (Malaysia) Sdn Bhd has ordered panel hospitals to prioritise local anaesthesia (LA) over general anaesthesia (GA) for procedures and surgeries, unless there are “clear clinical contraindications.”
The third-party administrator (TPA) in health insurance told panel health care providers that a recent audit found that a number of daycare procedures had been performed under GA instead of LA.
“Using GA in cases where LA would be clinically appropriate may expose patients to unnecessary risks associated with GA and result in higher costs for payers,” wrote MediExpress (Malaysia) Sdn Bhd medical director Dr Cheah Yt Jun in a memo yesterday to panel providers, as sighted by CodeBlue.
“We kindly request your cooperation in prioritising LA as the first-line anaesthesia modality for procedures and surgeries, unless there are clear clinical contraindications. If GA is medically required instead of LA, please provide a detailed justification for our review and records.”
MediExpress (Malaysia) Sdn Bhd – which is headquartered in Subang Jaya, Selangor – also reminded panel hospitals in its October 1 memo that certain procedures could be performed as daycare procedures without requiring overnight admission, citing its earlier July 3, 2025 memo.
“In cases where a guarantee letter (GL) is requested and, upon review, the procedure is deemed more suitable as a daycare service rather than inpatient, or where LA is preferred over GA, any deferment requests must be supported with appropriate justification prior to GL approval,” said Dr Cheah.
A “deferment” means that the TPA or insurer initially rejects a request for a GL or holds off approval until the panel hospital can provide acceptable clinical justifications. The patient can still go ahead with the procedure, but their insurance won’t pay for it at this time.
“Adhering to these guidelines is crucial for ensuring a safe, efficient, and patient-centred care experience while maintaining our commitment to clinical best practices, patient safety, and cost-effective care,” said Dr Cheah.
“We sincerely appreciate your continued support and dedication to delivering high-quality health care services.”
A CodeBlue search did not find Dr Cheah’s name on the National Specialist Register (NSR). According to her LinkedIn profile, prior to joining MediExpress, Dr Cheah was a clinic general practitioner (GP) for four years and a medical officer at a government hospital for less than two years before that.
According to MediExpress’ website, MediExpress – which comprises MediExpress (Malaysia) Sdn Bhd and Health Connect Sdn Bhd – is part of the Sumitomo Corporation Group from Japan.
MediExpress’ site lists its board of directors (chief executive officer Kenny Tai and chief strategic officer Shingo Yamashita), but does not provide details on either the names or specialties of the members of its medical panel.
MediExpress’ panel hospital listing, last updated on May 29, lists private hospitals, semi-government or university hospitals, and even government hospitals under the Ministry of Health (MOH), including rural district hospitals like Sarawak’s Kanowit Hospital and general hospitals like Kuala Lumpur Hospital (HKL), across the country.
Last December, Anthem Blue Cross Blue Shield, one of the largest health insurers in the United States, reversed its decision to no longer pay for anaesthesia care in certain states if the surgery or procedure goes beyond a particular time limit, following public backlash.
Anaesthesiologist Slams TPA Interference With Clinical Decision-Making
A consultant anaesthesiologist at a private hospital in Malaysia described MediExpress (Malaysia) Sdn Bhd’s memo to panel providers as prioritising costs over clinical decision-making.
He stressed that clinical decision-making was between the patient and doctor, including the right to choose the type of procedure relevant to the patient’s clinical condition.
“That right also includes the choice of anaesthesia,” the anaesthesiologist told CodeBlue when approached for comment, requesting anonymity due to fear of reprisal.
“The doctors will determine the modality after reviewing the risk of performing the anaesthesia under LA or GA. To write justification on why a modality is used for the purpose of payment adds another layer of complexity.”
The anaesthesiologist explained that some simple cases are performed under LA, but complicated sebaceous cyst removal may require GA if the cyst is stuck to nerves and vessels, for example.
“We have had cases where, despite explanation, it was still declined by insurance because they look at it as a cyst, so it can be done under local [anaesthesia]. But they don’t see it clinically as how we see it,” he said.
Another example is cataract surgery, most of which is performed under LA. The very few cataract procedures performed under GA are due to medical conditions, such as a patient having anxiety, problems keeping still, or neck or spine issues that cause them to fidget during the operation.
“So, in order to avoid injuries to the eye if they accidentally move, we do under GA,” said the anaesthesiologist. “But to insurance, all cataracts are the same.”
He observed that insurance companies sometimes disagreed with clinical justifications from health care providers and denied coverage for policyholders, telling patients to pay first and file a claim later.
“Some patients then decide that potentially, they won’t go ahead with the procedure for fear of not getting reimbursed.”
When asked whether clinicians or patients generally preferred GA over LA, the anaesthesiologist explained that preference depended on the situation.
Patients prefer LA most times as they’re afraid of not waking up after surgery, but others get scared and traumatised if a procedure is done under LA.
“So that’s the part where we rely on patient autonomy,” said the anaesthesiologist. “But autonomy isn’t necessarily covered under the policy.”
“For surgeons, they usually make that call after discussion with the patient. In some cases, LA is not an option at all. So that’s easy.
“It’s the case of whether it can be done under LA or GA which is the problem. There’s no right or wrong answer and has to be individually assessed. That’s where blanket memos like this are a problem.”
Health Minister Dzulkefly Ahmad told reporters yesterday that the issue of TPAs has been discussed in Cabinet, but said this wasn’t solely under MOH’s jurisdiction, as it involved other ministries like the Domestic Trade and Cost of Living Ministry (KPDN).
CodeBlue previously broke the story on a generic-only policy by MiCare Sdn Bhd, on behalf of a corporate client, to limit panel health care providers to generic versions for long-term medications. The TPA required prescriptions to list only the active ingredient.
Both the Association of Private Hospitals Malaysia (APHM) and the Malaysian Medical Association (MMA) have condemned the directive as potentially compromising the quality of care and undermining patient rights.
