https://www.freemalaysiatoday.com/category/nation/2025/02/26/higher-private-hospital-fees-for-patients-using-guarantee-letters-says-deputy-minister/

PETALING JAYA: 

Some patients using guarantee letters for private hospital treatment appear to be facing higher costs than those who pay upfront and claim reimbursement later, says deputy finance minister Lim Hui Ying.

Lim said this was based on an analysis of private hospital billing claims submitted to insurance companies and takaful operators (ITO), Bernama reported.

“Since the treatment charges imposed are less transparent, a more detailed study is required to better understand this issue and determine the appropriate follow-up measures,” she was quoted as saying during a question-and-answer session in the Dewan Rakyat today.

She was responding to Sim Tze Tzin (PH-Bayan Baru), who had asked the finance ministry to explain the price differences between the two payment methods.

A guarantee letter is a document issued by an insurance company or employer to a hospital or medical provider, guaranteeing payment for a patient’s treatment.

Lim said the government was aware of the concerns, which were also raised during recent public hearing sessions by the Public Accounts Committee (PAC).

She said the health ministry, in collaboration with the finance ministry, private hospitals, and ITOs, was working to find a long-term solution to the issue of rising medical costs and private hospital charges.

“This includes enhancing the transparency of medication costs and facilitating comparisons of common medical expenses. This integrated action plan was presented to PAC yesterday,” she said.

Lim also revealed that initial findings from the integrated claims database of the ITO industry showed high claim rates for certain illnesses in 2023 under medical and health insurance and takaful.

Among the most commonly claimed illnesses were pneumonia, spinal issues, digestive system disorders, and heart disease.

Bernama also reported Lim as saying that the government would conduct an in-depth study to assess the feasibility of detailed profit and loss reporting for each medical insurance policy.

ITOs currently only disclose overall financial statements under Malaysian Financial Reporting Standard 17, with premium adjustments based on claim costs.

Lim said ITOs must balance policyholder affordability and product sustainability when determining premium changes, ensuring that adjustments are based on the cost of claims and not solely for profit.

“For example, ITOs must monitor the cost experience of MHIT claims objectively, and may only adjust premiums when the actual claims costs consistently decline and exceed the threshold value previously set in the ITO’s internal practices.

“ITOs are also prohibited from resetting premiums solely to increase their profits,” she said in response to Teresa Kok (PH-Seputeh), who asked if companies would be required to provide detailed financial listings.

https://www.freemalaysiatoday.com/category/nation/2025/02/25/some-private-hospitals-face-removal-from-insurance-panels-says-group/

The Association of Private Hospitals Malaysia says its members are unable to fulfil insurers’ requests for ‘exorbitant’ discounts on patients’ bills.

PETALING JAYA: 

Several private hospitals may face removal from insurance panels soon due to their inability to meet requests by insurers for “exorbitant” discounts on patients’ bills, says the Association of Private Hospitals Malaysia (APHM).

The association said while its member hospitals had consistently provided “reasonable discounts to insurers, exorbitant discounts are not sustainable and will compromise the quality of care our patients expect to receive”.

“As private hospitals, our primary mission is to provide the best care for our patients.

“We strive to minimise delays that could affect patient outcomes while offering cutting-edge medical technology, expertise and services at a global standard.

“To maintain this level of care, APHM member hospitals reinvest profits annually into the latest technology and infrastructure, which we believe is vital to enhance patient treatment through less invasive procedures and improve survival rates,” said the association in a statement.

APHM president Kuljit Singh said even though the association’s member hospitals had been on the insurance panels for some time now, the discounts requested by insurers had increased greatly in the last 12 months or so.

“We always try our best to help the insurance companies.

“But the patient is our priority at the end of the day. We cannot cut corners to the point it becomes dangerous to the patient,” he said.

APHM said while patients could still seek treatment from delisted APHM member hospitals, they would have to pay their medical bills first and claim from their insurance provider later, as delisted hospitals would not get guarantee letters from insurers.

The association said it was currently engaged in discussions with the health ministry, Bank Negara Malaysia and the Public Accounts Committee to explore solutions to medical inflation.