Who can you complain to about private hospital care?
There has been a lot of discussion and argument over what the NHS will provide on cancer treatment
Some leading providers of private medical insurance UK have been concerned that cancer treatment has been available privately, but not under the NHS, and several have moved to include such cover in their policies.
Unfortunately, this fragmented approach has meant that each insurer- and often different policies from the same insurer but sold via different distributors, has their own unique approach to what types of cancer they cover, what cancer treatments they will allow, what the policy will pay, and for how long.
The ABI has a suggested guideline for insurers for cancer cover
This does not mean that all insurers all offer the same cancer cover.
Each insurer offers a variation on this or no cover at all - as the guideline has no legal status.
Not all insurers are members of the ABI.
The golden rule remains, if unsure what cover an insurer will offer on cancer - ASK.
Definition of cancer
The agreed definition of cancer is
- A malignant tumour, tissues or cells, characterised by the uncontrolled growth and spread of malignant cells and invasion of tissue
Insurers must have a distinct section in their policy documents to explain the cover for cancer. To allow for flexibility in approach, they may consider having a separate leaflet, or a separate section in a leaflet, to explain the cover for cancer. The explanation of the cover for cancer must be available at point of sale.
Insurers must explain clearly what would be covered, including limits on time periods, cycles of treatment, maximum payments, and circumstances in which they would not provide cover.
Place of treatment
- at home
What types they cover?
- to maintain remission
- maintenance therapy
- biological therapy
- including when given for pain relief
- maintenance therapy
- maintenance therapy
Is there a level of cover that is specific to cancer?
- experimental treatment / advanced therapy / prelicensed / NICE appraisal
- clinical trials
When referring to cancer, insurers may use terms such as 'preventative', 'maintenance', and 'palliative'. In order to increase clarity, they must avoid using the common definitions 'acute condition' or 'chronic condition' within this explanation of cover for cancer.
Cancer drugs: key points to consider
Each year, an estimated 280,000 men, women and children in the UK face up to the emotional and physical hardships of a cancer diagnosis.
For many, the strain of coping with their illness is compounded by the financial impact of an often sudden diagnosis, including loss of income after stopping work and having to pay for ongoing hospital visits and prescriptions.
But a postcode lottery still determines how far they are pushed into the red if they need expensive treatments for rare conditions, or to halt their cancer’s advance.
State funding for cancer drugs in England and Wales is determined by the National Institute for Clinical Excellence (Nice), which bases its decisions on whether there is enough clinical benefit to justify the expense. Nice is increasingly controversial for making decisions more on cost than on preventing people dying.
Patients can appeal against Nice decisions at the local level, under the exceptional case provisions. But the chances of winning at this stage will often come down to where the patient lives. A survey by the Rarer Cancers Forum (RCF) found huge variations in the way Primary Care Trusts decide on exceptional cases, with some approving all requests and others denying all. As money gets tighter the chances of local approval reduce.
Those patients who are not fortunate enough to win an appeal – or who don’t live in Scotland where many more cancer drugs are state-funded – must then find tens of thousands of pounds, often at short notice, if they are not insured. Some have even cashed in their pensions or sold their homes to get treatments to keep them alive.
Dozens of private medical insurance providers offer cancer cover to suit a range of budgets, either as a standalone benefit or as a feature rolled into their traditional PMI plans.
Health insurer WPA's 'My Cancer Drugs' is the only PMI plan on the market to be "drugs only" and was specifically designed to plug the NHS gap. It pays for cancer treatments licensed in the UK but not available on the NHS.
The insurer also offers 'NHS Health Top-Up' which is a health plan covering items such as dentistry bills, but also allows members to add cancer drugs cover for about £4 a month on top of their core premium.
These top-up plans are competitive but they do come with a benefits cap of £50,000 and exclusions for those with a history of cancer and those aged 65 or above.
Other providers offer cancer drugs cover as a standard benefit within their traditional PMI plans, with premiums ranging from £20 to £80 per month.
Key points to consider with any of these policies are benefit caps on drug spend and the kinds of drugs that will be covered. For example, some plans pay for any drug recommended by your oncologist, including those not licensed in the UK, or even experimental treatments.
To avoid unwelcome shocks, be clear about when your insurer might stop funding. Insurers use the term active treatment to govern their decisions on funding. But, unhelpfully, this definition differs from insurer to insurer.
Cancer charity Macmillan describe active treatment as treatment designed to affect the growth of cancer by shrinking, stabilising the tumour or slowing its spread, and not just treatment to relieve symptoms.
Some employers’ healthcare schemes will cover cancer.
Some providers of private medical insurance UK offer limited PMI plans where cancer is covered, and several are known to be developing special cancer-only policies.
Cancer-only policies are a lot cheaper than full covers, but if you buy a limited cover product make sure you fully understand what you are or are not covered for.
While such products can help reduce premiums, comprehensive health insurance covers most eventualities and gives peace of mind.