27 October 2025
When everyone acts like a doctor, no one truly takes responsibility. And in that chaos, the patient always loses.
Tag: third party administrators (TPAs)
23 October 2025
Malaysia
Insurance/Takaful Industry Touts 90% Medical Claims Approval Without Specifying GL Denial Rate
In response to CodeBlue’s poll among specialists, LIAM, MTA, and PIAM tout an average medical claims approval rate of over 90% in the insurance/takaful industry. But the associations omit details on the rate of guarantee letter (GL) denials or revocation.
23 October 2025
Bandar Kuching MP Dr Kelvin Yii slams ITOs/TPAs for interference and compromising clinical decisions in private health care at a huge scale, saying payers have “crossed the line”. The DAP MP demands an independent statutory Private Health Care Commission.
22 October 2025
Senior oncologist Dr Ibrahim Wahid slams ITOs/TPAs for questioning clinical decisions and denying coverage for lifesaving cancer drugs. An ITO demands up to 30% discounts from hospitals; some doctors lose cashless facilities if hospitals don't acquiesce.
16 October 2025
Malaysia
Insurance Denies Various Drug Claims In Malaysia, Including Expensive Innovators, Cheap Generics
Specialists say insurers are denying Malaysians life-saving medicines – from cancer therapies to diabetes drugs – by labelling them "non-medical" or "not indicated". Insurance denials span across both innovators and generics, costly and inexpensive drugs.
15 October 2025
In a poll, specialists say insurers routinely use “Deny, Delay, Revoke” tactics to dodge payment and control treatment: rejecting surgery, delaying emergencies, and revoking approvals even after care is given, describing a system stacked against patients.
14 October 2025
General practice is the backbone of Malaysia’s health care system. When GPs fail, the entire system falters, according to Dr Manmeet Rai.
14 October 2025
In a CodeBlue poll of 855 specialists in private hospitals in Malaysia, 99% perceive insurer interference with clinical decisions. 99% also say patients faced health insurance problems over the past year. Denials/delays forced referrals to govt hospitals.
13 October 2025
At a recent meeting between MediExpress and anaesthesiologist groups MSA and COA, plus doctors' group MMA, MediExpress reportedly clarified that its anaesthesia memo wasn't meant to interfere with clinical management. The meeting ended on a positive note.
10 October 2025
Despite a GP consultation fee ceiling increase to RM80, MMA expresses deep disappointment with the government retaining the RM10 floor rate, saying this low floor risks undercutting by TPAs who have been paying doctors below RM35. MMA wants RM50 minimum.