This management project examines the rising healthcare costs and increasing insurance coverage gaps affecting Pantai Hospital Manjung (PHM), particularly the growing rate of Guarantee Letter (GL) denials and delays that disrupt patient access and hospital operations. The project adopts a mixed-methods design, combining analysis of PHM’s GL rejection data with qualitative insights from clinicians, administrative staff, and financial teams to understand the organisational and systemic contributors to these issues. The findings show that pre-existing conditions and waiting-period clauses account for a significant proportion of denials, leading to deferred admissions and reduced continuity of care. Policy exclusions and medical-necessity disputes further highlight misalignment between clinical judgement and insurer requirements. Although administrative errors form a smaller share, they indicate workflow inconsistencies that contribute to avoidable delays. These patterns collectively affect patient behaviour, financial predictability, insurer–provider relationships, and PHM’s operational efficiency. The project concludes that targeted interventions—such as Value-Driven Outcomes (VDO) expansion, DRG-supported digital claims integration, structured insurer–provider governance and enhanced pre-admission counselling—are essential to reduce inefficiencies and support timely, equitable, and sustainable care delivery at PHM. Keywords: Healthcare Costs, Insurance Coverage, Healthcare Financing, Value-Based Healthcare, Private Healthcare