Critical illness insurance pays you for living - Revisit

Critical illness insurance pays you for living


This article first appeared in "Mind Your Body", a Straits Times Supplement.


Dr Ang Peng Tiam


The medical director of Parkway Cancer Centre has been treating cancer patients for nearly 20 years.


Buyers beware - Read the fine print


The financial world has been in turmoil recently. I understand very little of it because there is too much fine print – when even experts are divided on what is the right thing to do, what are retail investors to do?


Part of the problem arose because the financial instruments are just too sophisticated for laymen to understand. The banks which sold these products argue that the investors have been told of the risks. In fact, these risks have been spelt out in the contracts.

But if these points are buried in fine print, people just don’t take the time to plow through them all. They assume that they can trust their brokers and relationship managers to give them the best investment advice. And when their investment falls off the cliff, they feel shocked and betrayed.

All too often, I see this same problem with patients’ medical insurance.

Many buy health insurance because they understand the rising cost of health care and the need to protect themselves if they ill. They assume that if they have medical insurance, they are going to be able to afford medical care if the time comes.

I am not sure that this is true, 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 the illnesses. However, not all cancers are covered under this provision. There are many cancers, which are deemed “not serious” and are not 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 they do not get the money “promised” to them.

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

Back in the early 1990s, when I was working in 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 programs are designed to be administered once every 21 days).

I found out that the reason was that Medishield would only pay for treatment once every month. Many of these patients depended on the $700 from their basic Medishield. 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, I could not convince some who really needed the medical insurance to help out with their bills.

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

But this problem could surface with private insurers, some of which can opt to pay for one treatment a month. Not many people will realize the significance of this adjustment, until they need chemotherapy.

What happens is this – if two cycles of chemotherapy falls within a month, patients tell me that they can only claim for one. As most chemotherapy programs are administered every 21 days, the patient will not be able to claim for at least one or two cycles of treatment. For this reason, wherever possible, I try to start patients off on the first cycle towards the end of the month rather than the beginning.

My advice for those who are planning to buy or have already bought medical insurance is to read their contracts carefully. But 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 will work out a lot cheaper than finding out you don’t have the payout you thought you had if you fall ill.

Last, 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 statement 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 on Friday.