Grievance Mechanism Committee revived to address guarantee letter delays and treatment payment disputes in medical and health insurance sector.
KUALA LUMPUR: The government is reactivating the Grievance Mechanism Committee to resolve delays in guarantee letter issuance and treatment payment disputes.
Deputy Finance Minister Lim Hui Ying announced the revival alongside Bank Negara Malaysia and medical, hospital, insurance and takaful operator stakeholders.
She said the committee serves as an industry platform to tackle operational issues including harmonising procedures to reduce guarantee letter delays.
“The GMC may issue guidelines for payers, medical practitioners and healthcare providers as a reference for similar cases in the future,” she told the Dewan Rakyat.
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Lim was responding to a supplementary question from Sim Tze Tzin regarding medical insurance premium frameworks and third-party administrator roles.
She acknowledged medical cost inflation requires a “whole-of-nation” approach and long-term reforms for system resilience.
On third-party administrators, Lim said insurers must review claims according to contract terms and verify medical necessity.
“This review is conducted solely to confirm what is covered and claimable based on commonly accepted treatment protocols,” she explained.
When treatments deviate from standard protocols, insurance providers conduct further review to understand clinical reasons.
“If the treatment is found to be medically necessary, the claim must be paid,” Lim stated.
She emphasized this process controls medical claims inflation from wastage and abuse that could cause premium hikes.
Insurance providers and third-party administrators cannot determine patient care, which remains exclusively with doctors.
Lim noted industry data shows insurance providers maintain average claims approval rates exceeding 90%. – Bernama
