ITOs' Cashless Panel Decisions Subject To Contractual Terms, Procedures – HPPSC
KUALA LUMPUR, Nov 6 (Bernama) -- Insurance and takaful operators (ITOs) may review, withdraw or restrict a healthcare provider’s cashless privileges where it fails to comply with agreed contractual terms, claims procedures or other applicable requirements.
The Healthcare Partners Protocol and Solutions Committee (HPPSC) said, however, that 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does not, in itself, mean that a policyholder’s or certificate holder’s medical insurance or takaful coverage has been withdrawn.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,” it said in a statement today.
Cashless facilities are administrative arrangements offered by 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.
HPPSC also acknowledged 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,” it added.
HPPSC reiterated 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.
-- BERNAMA