CANCER patients are being abandoned mid-way through their treatment by private medical insurers who had promised to cover all their costs, a leading charity claimed yesterday.
CancerBACUP said that private insurers misled consumers about the nature and extent of the cancer care for which they would pay by filling their policy documents with opaque terms and conditions.
At least 270,000 people develop cancer for the first time every year. There are 6.7 million Britons covered by private medical insurance, bringing in £2.7 billion in premiums to insurers every year.
Only BUPA Insurance, Britain’s largest private health insurance company, covered patients throughout the course of their illness, CancerBACUP said, while other insurers stopped paying for treatment when it ceased being curative.
The charity claimed that private health insurance sales staff reassured callers that their policies would pay for any type of treatment, when in fact they would not. In other cases, staff from the same company gave out contradictory information. CancerBACUP refused to name and shame the worst insurers, because it said that it wanted to work with the industry.
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The Association of British Insurers said that it would consider changing its code of practice to force insurers to provide better descriptions of what policies covered. The association vowed to work with CancerBACUP to seek remedies to the issues.
The Financial Services Authority said that it would address the problem when it began regulating the sale of general insurance products in January 2005. “Our rules will require firms to be clear, fair and not misleading in their communications with customers,” an FSA spokeswoman said.
But a leading private medical insurer denied that the industry misled consumers and said that the real issue was that some consumers did not understand how private medical insurance worked.
“It’s a supplementary insurance, which complements the work of the NHS,” said David Costain, medical director of AXA PPP, Britain’s second-biggest medical insurer. “None of the PMI companies aim to provide comprehensive health cover, which is why it focuses on acute conditions.”
Dr Costain added: “The charity has picked up on the right issues; that people should understand what they’re buying and we should be clear on what we’re selling but I think AXA PPP does a good job.”
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Dr Natalie-Jane Macdonald, the medical director of BUPA Insurance, said that it supported CancerBACUP’s report. She said that BUPA spent £137 million a year on cancer treatment for its policyholders.
CancerBACUP surveyed eight private medical insurance companies, including all of Britain’s largest insurers and an even spread of provident associations and commercial insurers. Just over half of all private medical policies are sold by insurance brokers or financial advisers.
TREATMENT CAN COST £100,000
Dr David Costain, the medical director of AXA PPP, Britain’s second-largest private medical insurer, signs off every cheque sent out by the insurer for more than £50,000. Last week he signed 20 cheques for more than £100,000 each, to pay for cancer treatment for AXA PPP policyholders.
Dr Costain said that it could easily cost more than £100,000 to treat a long-running case of lung or breast cancer. About £10,000 will cover one bone marrow transplant for a leukaemia patient, while the same amount will pay for the surgical removal of one large cancer.
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A cycle of chemotherapy costs, on average, £3,000 but can go as high as £10,000. Most cancer patients have six cycles of chemotherapy, putting the cost of their treatment at at least £18,000. Hospital expenses can cost as much as £1,000 a day.
Medical advances have had a mixed effect on costs. Macmillan Cancer Relief said that patients were now less likely to undergo expensive invasive surgery and were more likely to have home treatment for longer.
THE JARGON LOOPHOLES
Private medical insurers (PMI) use jargon such as “active treatment” and “chronic condition” to avoid paying out for various cancer treatments, according to CancerBACUP, the leading cancer charity.
The charity said that its research revealed “weasel” words and phrases in insurers’ policy documents that made it impossible to understand what types of treatment were covered.
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One popular piece of jargon was active treatment, which was used by a number of insurers to explain the types of treatment that they would cover. CancerBACUP, however, said none of the insurers that used the phrase provided a definition of its meaning. Typically, cover for active treatment rules out treatments that are containing but not curing the cancer. It also means that palliative care is not covered.
Charity campaigners said they suspected the reason for the opacity in insurers’ policy documents was to allow insurers to decide whether to pay for treatment on a case-by-case basis, which was less expensive than providing blanket cover.