Transparency in medical billing vital

The Sun

28-04-2025

IN January 2025, chief executive of Galen Centre for Health and Social Policy Azrul Mohd Khalib highlighted that an estimated 70% of private hospital charges remain unregulated.
This means that hospitals have the liberty to set arbitrary prices for a range of items and services, including essential medical equipment such as wheelchairs, heart monitors and even emesis basins. Only 30% of hospital bills are regulated, primarily covering specialist fees and medication.
This lack of oversight has led to numerous cases where patients unknowingly pay excessive sum of medical bills for items that should otherwise be reasonably priced.
Hidden hospital charges, often labelled as profiteering, are a widespread problem in Malaysia. For example, a simple medical glove that costs RM5 per pair may be billed at RM20. In most cases, patients pay these inflated charges without question. This is because patients rarely scrutinise their medical bills, either due to a lack of knowledge or because they assume that everything charged is legitimate.
As a result, they end up shouldering excessive costs without the ability to challenge these expenses.
One of the most alarming aspects of hidden hospital charges is the suppression of information. Some hospitals use this tactic to increase their revenue without the patient's awareness.
Malaysia's current healthcare system lacks a clear mechanism for patients to challenge inflated or hidden costs, unlike in countries that have implemented price transparency regulations.
For instance, the US introduced the hospital price transparency rule on Jan 1, 2021, which makes it a requirement for hospitals to publicly disclose a list
of their standard charges for various services. This enables patients to compare hospital prices before seeking treatment and allowing them to make informed financial decisions regarding their medical care.
Similarly, Singapore was set to introduce the Health Information Bill in mid-2024, which would improve transparency in healthcare pricing and data management. The country also has a robust regulatory system where medical costs in public hospitals are monitored and pricing is often published online, allowing patients to compare treatment costs across different hospitals.
Australia follows a different but equally effective approach. The Australian government regulates healthcare pricing through the Medicare Benefits Schedule, which ensures that citizens and permanent residents receive subsidies for hospital services.
Private hospitals in Australia are required to provide financial consent before treatment, meaning patients must be informed about the estimated costs and any out-of-pocket expenses they may incur. This allows patients to plan their finances accordingly and prevents hospitals from imposing hidden charges after treatment.
Additionally, the Australian Competition and Consumer Commission closely monitors healthcare pricing to prevent exploitative billing practices. The right to know the cost of medical treatment is a fundamental consumer right that is often overlooked in Malaysia.
Patients should be entitled to an itemised bill that details each charge, allowing them to identify any unnecessary or excessive fees. Hospitals should also be required to disclose pricing structures upfront so that patients can make financial decisions with clarity.
In instances where patients identify unethical billing practices, they should have a legal avenue to dispute the charges.
Many patients are unaware of the steps they can take to protect themselves from hidden charges.
One of the most effective ways to safeguard against excessive billing is
to demand an itemised bill. By requesting a detailed breakdown of all charges, patients can scrutinise their medical expenses and challenge any discrepancies.
Furthermore, patients should not hesitate to dispute unethical fees. If a hospital bill contains unjustified charges, patients should engage with
the hospital's billing department to seek clarification.
In cases where disputes remain unresolved, patients should report the matter to the Health Ministry or the National Consumer Complaint Centre (NCCC). This organisation plays a crucial role in advocating for consumer rights and ensuring that unethical hospital billing practices are addressed.
Insurance also plays a crucial role in managing medical expenses. Patients must have a clear understanding of their insurance coverage, including which procedures and treatments are included and which are not.
Many insurance policies require pre-authorisation for specific treatments, making it essential for policyholders to obtain the necessary approvals before undergoing medical procedures.
Patients should communicate with their insurance providers to ensure they are fully aware of the coverage limitations and potential exclusions in their policies.
Key takeaways for understanding insurance include:
Always review the policy's terms and conditions to understand claimable and non-claimable expenses.
Verify whether a guarantee letter from the employer or insurer fully covers all medical treatments.
Ask for a pre-treatment estimate and clarify any potential additional costs before proceeding with medical procedures.
Ensure that any required pre-authorisations are obtained before undergoing hospital treatments.
To improve transparency and prevent hospitals from imposing unreasonable charges, the government should consider implementing several key reforms.
Firstly, the government should introduce regulations that mandate hospitals to disclose their pricing structures publicly. This would allow patients to compare costs across different hospitals and make informed decisions regarding their medical care.
For example, legal fees for lawyers are strictly regulated by the Solicitors' Remuneration Order 2023.
Secondly, an independent regulatory body should be established to oversee private hospital pricing and ensure that all charges are fair and justifiable. This body could also act as a mediator in billing disputes, providing patients with a channel to contest excessive fees.
Thirdly, greater public awareness initiatives should be launched to educate consumers on their rights in relation to hospital billing and insurance coverage. Many patients remain unaware of the steps they can take to protect themselves.
If faced with hidden charges, patients have several avenues for recourse. The first step is to file a complaint with the hospital's patient relations officer. If the issue remains unresolved, patients can escalate the complaint to the Health Ministry.
Additionally, consumer protection groups, such as NCCC, can assist in addressing cases of overpricing and unethical billing practices. By taking collective action, patients can play a significant role in pushing for greater transparency in the healthcare system.
The issue of hidden hospital charges is a growing concern and by looking
at international best practices and adopting measures to regulate hospital pricing, Malaysia can move towards a more transparent and fair healthcare system.
It is crucial for the government and consumers to work together in addressing this problem, ensuring that patients receive the medical care they need without being subjected to unjust financial strain. The time for change is now and concrete steps must be taken to protect the rights and financial well-being of patients.
In response to these systemic issues, Fomca (Federation of Malaysian Consumers Associations) has been lobbying for the establishment of an independent oversight body to regulate managed healthcare insurance third-party administrators (MHIT) and private hospitals.
This body would play a vital role in ensuring accountability, transparency and fairness in billing practices, and it would also serve as a mediator in dispute resolutions between consumers, insurance providers and healthcare institutions.
Fomca believes that such a regulatory framework is long overdue. The absence of regulatory safeguards has allowed MHIT and private hospitals to act with near-impunity, often leaving patients helpless in contesting exorbitant medical bills.
NCCC