Third party administrators, insurance and takaful operators can’t prescribe treatment, Dewan Rakyat told

It has been alleged that insurance and takaful operators were interfering in decisions related to treatment of patients.

KUALA LUMPUR: The finance ministry said insurance and takaful operators (ITO) and third-party administrators (TPAs) are not authorised to prescribe treatment for patients, as criticism mounts over their alleged interference.

Deputy finance minister Lim Hui Ying said the exclusive right to determine patient care remains reserved for doctors.

“And if the insurance policy does not cover the treatment, then patients can pay for it out of pocket,” she told the Dewan Rakyat.

Lim said this in response to a supplementary question by Sim Tze Tzin (PH-Bayan Baru), who asked about the measures undertaken by the government to address issues highlighted following the imposition of Bank Negara Malaysia’s interim measures to tackle the rise in medical insurance premiums using existing laws.

Among the issues highlighted by the PKR MP were the interference of ITO in clinical decisions, retraction of guarantee letters, rejection of claims using reasons that treatment does not adhere to protocols, a steep hike in insurance premiums due to age brackets, and slashing of coverage periods.

In her response, Lim also revealed that the data provided by the ITO industry shows that it has maintained an average 90% of claims approval rate.

However, the government, together with the central bank, the medical industry, hospitals and ITOs are reactivating the Grievance Mechanism Committee (GMC).

The GMC deals with issues related to business operational practices to reduce delays in the issuance of guarantee letters and look into cases of disputes on coverage.

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