PETALING JAYA: Ideal cancer treatment options for insured patients are being delayed, with insurance companies ignoring clinical needs and dictating terms, including downgrading medical procedures, says National Cancer Society of Malaysia (NCSM) managing director Prof Dr M. Murallitharan.
He said some patients are often caught in a quandary when insurers question recommended procedures by doctors, withholding approvals or demanding further justification before critical treatment can proceed.
"We have patients who are already hospitalised for the removal of malignant tumours. But due to complications in their conditions, the surgery necessitates a more extensive procedure.
"Unfortunately, consent from insurers is delayed as they question doctors regarding the necessity of certain procedures. This leads to the surgery being delayed.
"In some cases, surgery has to be downgraded. Instead of the latest, sophisticated technology, doctors are being pushed towards conventional methods simply because they must work around the limitations or conditions set by insurers.
"For cancer patients, time is precious and delays can be dangerous," he told The Star.
He added that there have been instances where doctors found themselves in challenging situations, resulting in the need for patients to be transferred to different hospitals for treatment.
He said this has created non- standardised treatment patterns.
"Cancer treatment is actually straightforward. There are clear medical guidelines, but what we are seeing now is treatment shaped around insurance conditions," Prof Murallitharan added.
He said the claims department of insurers must develop a deeper understanding of cancer therapy. Insurers should not cause delays, question or reject applications for treatment and medical procedures.
He also said insurers must stay updated with the availability of newer treatments instead of referring to outdated practices.
Another big hurdle, he noted, is access to new cancer drugs and treatments that are not covered by insurance.
"Many policies only pay when the patient is warded. But when the same treatment is done as an outpatient, which is common and medically sound, it is not covered.
"Most medical insurance only covers 90 days of medication, while cancer drugs can be required for many months or even years. At times, this leaves doctors hesitant to prescribe what is medically ideal," he said.
He said the situation is not entirely the insurers' fault in some cases, as policyholders underestimate rising healthcare costs and fail to update their coverage.
He advised patients not to assume that an old policy will automatically protect them, as cancer treatment is costly and coverage that seemed sufficient 10 years ago may now be barely enough.
"Charges will continue to rise. Policyholders must re-examine their coverage and ideally buy young, when premiums are lower," Prof Murallitharan said.
He said that for cancer patients who are financially strapped, the NCSM provides patient navigation services to guide them on what their insurance coverage entitles them to.
He said they are also assisted with sourcing for low-cost treatment options, charitable programmes and drug access schemes.
"Through partnerships with overseas charitable organisations, we have provided 200 patients from government hospitals with medications valued at RM27,000, at minimal or no cost to them.
"Every ringgit that we help them save can be channelled back into other treatments," Prof Murallitharan said.
Meanwhile, Association of Private Hospitals Malaysia president Datuk Dr Kuljit Singh said the association is aware that insurance denials involving cancer patients can be highly distressing not only for patients and their families, but also for the doctors treating them.
He said doctors, third-party administrators and insurers must work together to ensure that patients clearly understand the scope and limitations of their coverage as well as the treatment options available.
"To support this, many private hospitals are offering complimentary financial counselling services to help patients make informed decisions about treatment costs and financial planning," he said.
Dr Kuljit urged patients who feel they have been treated unfairly, or who face difficulties with their insurance coverage, to pursue assistance through the appropriate channels.