third-party administrators (TPAs) Archives

5 November 2026

Letter

Insurers Must Expand GP Coverage To Curb Rising Private Health Care Costs — PMPASKL

PMPASKL backs APHM’s warning that patients bypassing GPs for routine illnesses are contributing to rising private health care costs. It urges insurers and TPAs to expand outpatient GP coverage to curb unnecessary hospital visits.

21 May 2026

Malaysia

MMC Bans Doctor Fee-Splitting By Hospitals, Insurers, TPAs

MMC has banned fee-splitting practices involving specialists or GPs by arrangements between private hospitals and ITOs or TPAs, amid payers squeezing providers for discounts that force doctors to cut their professional fees to stay on insurer/TPA panels.

29 November 2025

Malaysia

Health Ministry Forming National Registry Of MCOs, TPAs

MOH is setting up a national managed care organisation (MCO)/third-party administrator (TPA) registry. All MCOs/TPAs are compelled to furnish information to MOH, including a sample contractual agreement with a private health care facility, by Jan 31, 2026.

10 November 2025

Malaysia

Bank Negara Wants Explanation From ITOs, TPAs On Clinical Interference

Bank Negara is seeking explanations from ITOs and TPAs on their alleged interference with doctors’ clinical decisions, including GL denial, delay, revocation; denying diagnostic tests; questioning a procedure or admission; or dictating treatment modality.

31 October 2025

Letter

Malaysian Health Care Needs Urgent Reform — Dr Goh Heong Keong

Nephrologist Dr Goh Heong Keong laments inertia in health care cost regulation. Insurance companies and TPAs exert immense pressure on doctors for substantial discounts, affecting doctors' ability to maintain their practice and deliver comprehensive care.

30 October 2025

Malaysia

MOH Warns Against ‘Financial Gatekeeping’ In Medical Practice

MOH raises concern over practices that compromise clinical independence or patient safety. Decisions on anaesthesia, treatment modality, admission status must be based on clinical need and ethical standards, not admin directives or financial gatekeeping.

29 October 2025

Malaysia

Patients Can Sue Health Insurers, TPAs For Denials, Delays: Lawyer

Lawyer Raja Eileen Soraya says patients can sue ITO/TPAs if they’re harmed by health insurance denials or delays. Lawsuits can be filed under common law for breach of contract. At MLSM's conference, it was agreed that a test case may be needed in Malaysia.

24 October 2025

Malaysia

ITOs, TPAs Not Authorised To ‘Direct’ Patient Care: Bank Negara

Bank Negara says ITOs and TPAs are not authorised to "direct" patient care, adding that ITOs assess medical claims based on "accepted treatment protocols", as guided by CPG. Claims must be honoured if treatments are established to be "medically necessary".

24 October 2025

Malaysia

MCA Demands Laws For Patient Protection From Insurance Denials, Delays

MCA president Wee Ka Siong urges laws to protect patients from health insurance denials, delays, and revocation of GLs, including prohibitions on exclusions from pre-existing conditions. MCA demands an independent statutory Private Health Care Commission.

22 October 2025

Malaysia

CodeBlue Releases Full Responses In Health Insurance Survey

CodeBlue is releasing the full anonymised responses in our poll among more than 850 specialists in the private sector on health insurance issues in Malaysia. Our 200-page report can be downloaded from inside this article.

Tag: third-party administrators (TPAs)

Insurers Must Expand GP Coverage To Curb Rising Private Health Care Costs — PMPASKL

MMC Bans Doctor Fee-Splitting By Hospitals, Insurers, TPAs

Health Ministry Forming National Registry Of MCOs, TPAs

Bank Negara Wants Explanation From ITOs, TPAs On Clinical Interference

Malaysian Health Care Needs Urgent Reform — Dr Goh Heong Keong

MOH Warns Against ‘Financial Gatekeeping’ In Medical Practice

Patients Can Sue Health Insurers, TPAs For Denials, Delays: Lawyer

ITOs, TPAs Not Authorised To ‘Direct’ Patient Care: Bank Negara

MCA Demands Laws For Patient Protection From Insurance Denials, Delays

CodeBlue Releases Full Responses In Health Insurance Survey

Patients Skipping GPs For Private Hospitals Drive Up Medical Costs: APHM

Poisons Board Endorses Proposed Exemption Of Liquid Nicotine

Seniors Need Retirement Income Without Burdening Their Children: KALSIS

Beyond The Building: Examining Systems At Klinik Kesihatan Kuala Lumpur — A Concerned Health Care Staff Member

Malaysia Needs MHTC-Like Agency To Coordinate Long-Term Care