KUALA LUMPUR: Many insured patients face issues when accessing treatment at private hospitals because they do not know the details in their policies.

Association of Private Hospitals Malaysia president Datuk Dr Kuljit Singh said this was why insurers must ensure that their customers know what they were insured for and what they would need to pay for.

"One major issue is that many patients are unable to access treatment at certain hospitals due to specific arrangements made by their insurers," he said.

These arrangements might involve cashless facilities or other options, where the patient had to cover the cost first and subsequently seek reimbursement from the insurance company.

"This inconsistency can create confusion for patients, particularly when some hospitals offer cashless options and others do not."

Dr Kuljit said one of the challenges private hospitals face was managing the expectations of insured patients.

"Many patients expect to have the liberty to select their own doctor and hospital, often based on recommendations from friends or previous experiences.

"However, this could be challenging without access to cashless facilities as they may not have the means to pay upfront and claim reimbursement later.

"The same issue applies to co-payments, as they would need to cover part of the treatment cost out of their own pocket.

"Managing these expectations can be challenging without the proper facilities in place."

He said where healthcare providers were concerned, their priority was on patient care.

"As healthcare providers, we face the challenge of managing treatment while also dealing with payment constraints.

"Our main concern is to ensure that the patient receives the care they need, regardless of financial or administrative hurdles," he said.

https://www.nst.com.my/news/nation/2024/09/1105824/managing-expectations-insured-patients-very-challenging