Ismail Sabri raises alarm over surgeries cut short when doctors dropped from insurance panels

PARLIAMENT | Former prime minister Ismail Sabri Yaakob has claimed that some patients had their surgeries halted midway after the specialist attending to them was removed from an insurer’s cashless panel, forcing hospitals to call in doctors from elsewhere.

The Bera MP raised the matter while debating Budget 2027 at the committee stage in the Dewan Rakyat today.

“I was informed that there are specialist doctors who have been removed from insurers’ cashless facilities, to the extent that there have been cases where patients undergoing surgery had to stop because the doctor on duty did not have cashless facilities,” he said.

However, Ismail Sabri did not identify the hospital, doctor, or insurer involved. Malaysiakini has contacted him for further information.

Cashless facilities allow medical insurance or takaful policyholders to receive treatment without having to pay eligible medical bills upfront.

Under the arrangement, hospitals notify insurers or takaful operators of a patient's admission, diagnosis, and planned treatment. The insurer then issues a guarantee letter once coverage eligibility is confirmed.

However, the facility is generally restricted to hospitals and specialists on the insurer's panel. Patients treated by doctors or at hospitals outside the panel must settle their bills first before seeking reimbursement.

In February 2025, the Association of Private Hospitals Malaysia (APHM) warned that several private hospitals risked being dropped from insurance panels after failing to meet insurers' demands for discounts on treatment charges.

Specialists lose cashless facilities

Earlier, Ismail Sabri questioned the criteria insurers use to remove specialists from their panels, saying this effectively gave them considerable power over which doctors patients could see.

He asked whether such decisions were based on clinical performance, ethical or professional issues, documentation shortcomings, or purely commercial considerations.

If the decisions were commercially driven, he questioned what safeguards existed to prevent doctors from being arbitrarily sidelined without a transparent and fair assessment.

Citing estimates by the Malaysian Medical Association (MMA), Ismail Sabri said about 190 specialist doctors nationwide had lost their cashless facilities, a situation he described as deeply worrying because patients ultimately bear the consequences in terms of access to and continuity of care.

“I ask Bank Negara to clarify whether there are specific guidelines requiring insurers to provide written reasons and evidence, as well as a right of appeal, before removing a doctor from their panel.

“Where are the rights of patients who pay premiums every month, when insurers determine their choice of doctors?” he asked.

The Bera MP also questioned whether insurers were complying with the Malaysian Medical Council’s (MMC) principle of protecting patients’ right to choose their doctors.

Retrospective audits and outdated systems

Ismail Sabri further claimed that some insurers had conducted retrospective audits of claims that had already been approved.

“I do not deny insurers’ right to audit, but the process must be regulated to prevent abuse, especially when it involves access to patients’ confidential and sensitive medical records.

“There are hospitals that have been asked to repay claims and offer discounts to avoid being de-panelled, while specialist doctors lose their cashless facilities.

“Is Bank Negara aware of and monitoring this practice?” he asked.

He also said medical coding systems, forms, pre-approval procedures, and insurance payment rates had failed to keep pace with advances in medical technology, including robotic surgery.

“It is unreasonable for doctors to be blamed merely for confusion when filling out forms if the system itself does not provide the right options,” he said.

He called on Bank Negara and the Health Ministry to establish clear protocols and a framework governing panel restrictions, guarantee letters, and the continuation of treatment.

He also proposed that professional bodies and the insurance industry regularly review diagnosis and medical procedure codes to keep up with technological advances.

Minister promises talks

Meanwhile, Finance Minister II, Amir Hamzah Azizan, stated in his winding-up speech that he will discuss matters with Bank Negara.

"The oversight of the insurance industry falls under Bank Negara, and this is an initiative where the central bank will look into the procedures established by insurance operators.

"The issues raised will be discussed with Bank Negara. However, what is also important is ensuring that all industry players comply with sound regulations that will not drive up medical inflation, because if medical inflation rises, everyone will end up paying more.

"Therefore, this approach is also meant to ensure that those permitted to use cashless facilities are those who truly abide by the regulations as well. Nevertheless, I will continue to hold discussions with Bank Negara," he said.

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