KUALA LUMPUR, March 13 — Insurance companies sometimes withdraw guarantee letters (GLs) during a patient’s treatment due to assessments made by medical officers (MOs) rather than specialists, the Association of Private Hospitals Malaysia (APHM) said.
Speaking on the Keluar Sekejap podcast co-hosted by former Health Minister Khairy Jamaluddin and Shahril Hamdan last Friday, APHM president Dr Kuljit Singh alluded to insurers withdrawing GLs based on assessments by their medical officers (MOs), who may lack the expertise of specialists in private hospitals.
“That can happen. During patient visits, insurers may feel there is an issue—these can vary. It could be a patient issue, an unpaid premium, or the patient’s coverage nearing its ceiling. In such cases, insurers may withdraw the GL,” Dr Kuljit said.
“But sometimes, there is no reason why. Maybe the reason will come out at a later stage. Or maybe sometimes insurers say their information might not be enough. But doctors will give all the information.
“There can also be a problem on the insurance side. They may not have expert specialists who are very detailed like what we have in the hospital—that is indeed their difficulty because sometimes it is just an ordinary medical officer, not a nephrology specialist, not a cardiothoracic specialist, so maybe there is a bit of misunderstanding between their medical team and the specialist at the private hospital.
“So that’s where sometimes GL withdrawal can happen.”
Khairy questioned whether private hospitals, insurers, and regulators such as the Ministry of Health (MOH) and Bank Negara Malaysia (BNM) regularly engaged to address such concerns.
“Is there no industry stakeholder engagement that happens regularly between private hospitals, insurance companies, and regulatory bodies like MOH and BNM?” he asked.
“I know the answer to this, obviously, but I want to ask APHM, surely this must be taking place regularly to resolve issues like this. Otherwise, we end up with situations where insurers threaten to leave a hospital panel if they don’t get a discount, which signals something is wrong.”
Dr Kuljit said discussions frequently take place between insurers and private hospitals, but without the involvement of the MOH.
“LIAM (Life Insurance Association of Malaysia) and PIAM (Persatuan Insurans Am Malaysia) have regular discussions with us [APHM], and we have a very cordial relationship. We present and discuss many issues, but without MOH. We do sit together, and discussions are mostly cordial,” Dr Kuljit said.
“But recently, with rising costs and inflation, insurers may be struggling to absorb some of the expenses. That has created some friction. However, to answer the question, we have had a good relationship with insurers for years. There is no issue because, for us, their client is our patient. And the most important person in this equation is the patient,” he added.
