Ensure you're covered

Not all cancers may be covered by your medical insurance, so make sure you've got the right plans

By Dr Ang Peng Tiam

The financial world has recently been in turmoil. I understand very little of it because there is too much fine print. Even experts are divided on what is the right thing to do next.

Retail investors are even more confused. Financial instruments have become too sophisticated for the layman to understand.

The bank retailers argue that investors have been told of the risks, spelt out in the contracts.

However, if these points are buried in the fine print, many people just don't go through them. They assume that they can trust their brokers and relationship managers to give them the best investment advice.

When their investment falls off the cliff, they feel shocked and betrayed.

All too often, I see this same problem when it comes to patients' medical insurance.

Many of the people who buy health insurance do so because they understand the rising costs of health care and the need to protect themselves if they get sick.

They assume that if they have medical insurance, they will be able to afford the medical care they need.

I am not sure that this is always the case, especially when the illness is cancer.

There is a form of medical insurance that pays out a lump sum upon diagnosis of a "critical illness". Cancer, being the leading cause of death in Singapore, is of course included as one of these illnesses.

However, not all cancers are covered under this provision. There are many cancers that are deemed "not serious" enough to be included. For example, pre-cancerous conditions like non-invasive breast cancer or cancers with low risk of metastases, like skin cancer, are excluded.

Sometimes, patients cannot understand why they have been diagnosed with cancer and yet cannot get the money "promised" to them.

Another form of medical insurance helps to pay the hospitalisation, radiotherapy and chemotherapy bills.

Back in the early 1990s, when I was working at Singapore General Hospital, I noticed a trend of cancer patients delaying chemotherapy by a week or 10 days.

I did not think much of it until I started asking them why they did not keep to the appointed schedule of three weeks (most chemotherapy programmes are designed to be administered once every 21 days).

The reason was that the MediShield insurance would pay for the treatment only once a month, and many of these patients depended on the $700 from their basic MediShield plan. I tried my best to discourage them from delaying treatment as this could have a significant impact on their overall results.

No matter what I said, though, I could not convince some, as they needed the insurance to help out with their bills.

I eventually brought this matter up and after some discussion, the Central Provident Fund Board, which runs the MediShield scheme, agreed to change the coverage for chemotherapy to every 21-day treatment cycle.

This problem, however, could still surface with private insurers, some of whom can opt to pay for one treatment a month.

Not many people will realise the significance of this adjustment until they need chemotherapy.

What happens is this: If two cycles of chemotherapy fall within a month, patients tell me that they can claim for only one. As most chemotherapy programmes are administered every 21 days, the patient will not be able to claim for at least one cycle of treatment.

For this reason, wherever possible, I try to start patients off on the first cycle near the end of the month rather than at the beginning.

My advice to those who are planning to buy or have already bought medical insurance is to read their contracts carefully.

Even this may not remove all perplexities. If you are really puzzled, here's a radical suggestion: Pay your family doctor a fee of, say, $100 to go through the medical aspects of insurance agreements so that you understand what you are buying.

This could work out to be a lot cheaper than finding out that you don't have the pay-out you thought you had should you fall ill.

Lastly, knowledge really is power. Some years ago, a patient of mine told me meekly: "My insurance agent said that I couldn't make a claim because my liver cancer has not spread."

That must have been one of the most ludicrous statements I have ever heard.

I said to her: "You tell your agent that if he does not pay out by this Saturday, I will be on a soap box outside Tangs along Orchard Road, telling people about this case and asking them not to buy insurance from his company."

The insurance company agreed to settle the claims that Friday.