HPPSC REAFFIRMS COMMITMENT TO TRANSPARENCY, COLLABORATION AND PATIENT CARE AMID CONCERNS OVER CASHLESS PANEL ARRANGEMENTS
Kuala Lumpur, 6 November 2026 – The Healthcare Partners Protocol & Solutions Committee (HPPSC) acknowledges the concerns raised recently regarding cashless panel arrangements and the questions that have arisen regarding access to treatment and continuity of care. The Committee remains committed to supporting patient access to quality healthcare while contributing to the long-term affordability and sustainability of medical and health insurance and takaful solutions for all Malaysians.
HPPSC recognises that timely access to appropriate medical treatment and continuity of care are important considerations for patients. These concerns highlight the importance of effective communication, transparent processes and constructive collaboration among healthcare providers, hospitals, insurers and takaful operators.
As a multi-stakeholder platform comprising representatives from the Malaysian Medical Association (MMA), Association of Private Hospitals Malaysia (APHM), Life Insurance Association of Malaysia (LIAM), Malaysian Takaful Association (MTA), Persatuan Insurans Am Malaysia (PIAM), third-party administrators (TPAs) and a patient advocate, with Bank Negara Malaysia (BNM) and the Ministry of Health Malaysia (MOH) participating as observers, HPPSC provides a platform to address systemic issues and develop practical solutions to improve medical claims management and healthcare delivery.
1. Understanding Cashless Facilities and Medical Insurance/Takaful Coverage
It is important to distinguish between cashless facilities and the underlying medical insurance or takaful coverage.
Cashless facilities are administrative arrangements offered by Insurance and Takaful Operators (ITOs) to facilitate access to medical treatment without requiring policyholders or certificate holders to pay the full medical bill upfront, subject to the applicable policy terms and arrangements.
ITOs may review, withdraw or restrict a provider’s cashless privileges where the provider fails to comply with agreed contractual terms, claims procedures or other applicable requirements. Such decisions are based on the relevant circumstances and handled through appropriate procedures.
The withdrawal of a healthcare provider’s cashless privileges does not, in itself, mean that a policyholder’s or certificate holder’s medical insurance or takaful coverage has been withdrawn. Policyholders or certificate holders may still submit claims for eligible treatment received at licensed healthcare providers, whether or not the providers are on the respective ITOs’ panels, subject to the terms and conditions of their policies or certificates and applicable claims procedures.
The availability of cashless facilities and claim reimbursement arrangements may differ depending on the provider and the terms and conditions of the policy or certificate.
HPPSC encourages policyholders and certificate holders to check with their respective ITOs on the applicable claims procedures and payment arrangements before seeking treatment, where practicable, to minimise unexpected out-of-pocket expenses.
2. Strengthening Transparency and Governance in Provider Panel Management
The issue of de-panelling has been discussed extensively at HPPSC. Through engagement and collaboration among the relevant stakeholders, efforts have been undertaken to promote greater consistency, transparency and fairness in the process of reviewing healthcare providers’ and medical practitioners’ participation in cashless panel arrangements.
In August 2026, the HPPSC developed and agreed to adopt a framework on de-panelling, which has since been incorporated into BNM’s guidelines issued to ITOs. The guidelines set out requirements for transparent communication and engagement with affected healthcare providers and medical practitioners, including criteria used to assess providers, as well as processes for appeal and re-panelling. These measures are intended to provide greater clarity and transparency on the basis for de-panelling decisions, while allowing affected healthcare providers to better understand the reasons for such decisions and provide feedback or clarification where necessary. They also ensure that concerns relating to panel participation can be raised and addressed through established processes and appropriate channels.
HPPSC believes that constructive engagement and clear communication between ITOs and healthcare providers are essential to resolving differences and ensuring that decisions affecting panel arrangements are handled appropriately.
3. Enhancing Communication Between Doctors and ITOs
Recognising the importance of timely clinical engagement in medical claims assessment and continuity of patient care, HPPSC has facilitated the implementation of a dedicated doctor-to-doctor hotline between treating specialists and the medical advisory teams of ITOs.
The hotline, which has been operational since 30 April 2026, provides a direct channel for medical practitioners and ITO medical advisors to discuss clinical queries, clarify treatment pathways, exchange relevant medical information and address issues that may arise during the medical claims assessment process.
This initiative supports timely clinical dialogue, reduces communication gaps and facilitates faster resolution of queries, particularly in cases involving ongoing treatment or time-sensitive medical procedures. It also reflects HPPSC's commitment to improving transparency, strengthening collaboration between healthcare providers and ITOs, and supporting informed decision-making that prioritises patient welfare and continuity of care.
4. Improving Claims Management and Operational Processes
HPPSC is also undertaking several initiatives to improve the consistency, efficiency and transparency of medical claims management across the healthcare ecosystem.
These include developing standardised protocols to address clinical queries involving treatments that may not be directly aligned with existing Clinical Practice Guidelines (CPGs), as well as best practice recommendations for assessing coverage considerations involving emerging medical technologies, new procedures, diagnostics and treatments.
HPPSC is also working towards improving the Guarantee Letter (GL) issuance process to facilitate more efficient communication and coordination among ITOs, TPAs, medical practitioners and hospitals.
These efforts are intended to address operational gaps, improve consistency in claims assessment and support more efficient interactions between healthcare providers and healthcare financing stakeholders, taking into consideration evolving medical practices and technologies.
5. Commitment to Patient Care and Healthcare Sustainability
HPPSC acknowledges the concerns surrounding cashless panel arrangements and recognises the importance of efficient claims processes, timely communication and continuity of care, particularly for patients undergoing ongoing treatment or scheduled procedures. Through constructive engagement and collaboration among the relevant stakeholders, HPPSC remains committed to addressing systemic challenges, safeguarding patient interests and supporting a sustainable healthcare ecosystem.
Moving Forward
HPPSC reiterates its commitment to providing a collaborative platform for healthcare providers and healthcare financing stakeholders to address systemic challenges, strengthen operational protocols and develop practical solutions for the benefit of patients and policyholders.
The Committee will continue to facilitate constructive engagement among all stakeholders, with a shared objective of improving transparency, strengthening trust, enhancing operational efficiency and supporting better patient outcomes. Doctors and healthcare professionals who have concerns or wish to highlight issues relating to claims processes, panel arrangements or continuity of patient care are advised to reach out to their respective Associations. Their feedback and insights are important in helping HPPSC identify areas of improvements and work towards practical, sustainable solutions for the benefits of patients and the wider healthcare ecosystem.
Ultimately, a sustainable healthcare ecosystem requires shared responsibility, mutual understanding and continued collaboration to ensure that Malaysians have access to quality healthcare and sustainable medical and health insurance/takaful protection.
