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What Women Need To Know To Ensure Optimum Insurance Coverage For Breast Cancer

It doesn’t matter if the treatment is old or new, breast cancer treatments should be covered by insurance regardless, says consultant breast surgeon Dr Ng Char Hong.

The pink ribbon symbolises breast cancer awareness. Picture by iStock.com/PORNCHAI SODA.

KUALA LUMPUR, Sept 29 — Women need to be proactive when it comes to ensuring their breast cancer medical needs are met by understanding their options and voicing out their demands for comprehensive health care insurance that adequately covers the broad range of services and treatments for breast cancer, said Dr Ng Char Hong, a consultant breast surgeon at Sunway Medical Centre.

When they go for job interviews, aside from questions about salary, women should also ask potential employers what type of health benefits the company offers its employees, he said during a panel at the launch of the HER Time Matters campaign by pharmaceutical company Roche Malaysia on September 22.

Most health screenings in private hospitals, including mammograms, are conducted because employers provide these benefits for their employees, he said.

“If you look at the statistics, in private hospitals, a lot of mammograms are done on patients who are from the private sector, rather than government employees, because they are afforded these benefits by their companies,” according to Dr Ng.

If they are entitled to a mammogram, they should also get specifics about where they can get the mammogram done, Dr Ng said.

“There are a variety of mammogram machines in the country. You have the very old analogue machines that are really very painful and are not supposed to be functional anymore, to the normal digital ones, to the current 3D tomo (digital tomosynthesis 3D mammograms).

“Of course, 3D tomos are more accurate and their images are nicer, but women need to know that as long as the mammograms machines are digital and above that is fine, as long as it’s not an analogue machine.”

Furthermore, from screening to diagnosis and treatment, women need to know what kind of services, surgeries and therapies are available to them, Dr Ng said. “Twenty-five per cent of my patients come in with their insurance policy and ask me: how much do I get covered and can it cover all my treatments?”

Most of the time, patients have policies that are worth around RM60,000 to RM70,000 per year, which are usually sufficient to cover surgery, chemotherapy, and radiotherapy. The policies probably won’t cover targeted therapies and other more advanced treatments.

However, when insurance companies refuse to cover targeted therapy, Dr Ng said letters have been issued asking them to provide a reason why.

“We say give us a letter saying why you don’t cover it and I will send the letter to Bank Negara Malaysia (BNM) and ask them why you can’t cover it. And then they will revert back and say they will cover it, most of the time. 

“BNM governs all matters related to insurance. So, there is a form on their website that you can fill up to file a complaint.”

Most of his patients also tell him that their insurance won’t cover reconstruction surgery. However, in all of Dr Ng’s time as a surgeon in the private sector since 2014, all of his patients have been covered by their insurance for reconstruction surgery.

“We have made it a point to let insurance companies know that they should cover all reconstructions. And they have kind of verbally agreed that they would cover these procedures,” he said.

“Occasionally, some will send query letters to us and ask, is this a cosmetic surgery? Our answer is standard: reconstruction for breast cancer patients is definitely not cosmetic surgery.”

Make Your Voices Heard

While it is important for health care providers to fight for their patients, he said that patients should also do the same for themselves.

“Half the time, patients are just like, ‘it’s oklah, I just pay’. It’s like, no way right? You are covered by insurance so they should cover your treatment,” Dr Ng said.

“It doesn’t matter whether the treatment is new or old. A treatment for breast cancer is a treatment for breast cancer.”

Top: Patricia (moderator), Middle: Deepti Saraf, Dr Ng Char Hong and Jojo Struys, Bottom: Polin Lim and Dr Wan Hilya Munira Mustapha. Screenshot from launch of HER Time Matters campaign.

The HER Time Matters campaign, which was launched to mark Breast Cancer Awareness Month 2022 in October, is aimed at encouraging women to be more aware of breast cancer care and to take proactive management of their own health by coming up with a “future proof health care plan”.

Polin Lim, founder of The Asian Women (TAW), which is a partner in the campaign said: “A future proof health care plan is integrated with our insurance coverage and I think with insurance there are two things that every woman needs to know. One is the coverage limit and the second is the breadth of the coverage.”

She said it would be a shame for women to go see the doctor, understand the treatments they need, but realise that they will not be covered by their insurance.

When it comes to breadth of coverage, Polin maintained that breast cancer is an exciting medical field. “There are constantly new diagnostic tests and new treatments out there. There’s even a test now to tell you whether the chemotherapy is going to make a difference for you.”

However, she said the test is very expensive and costs in the five-figure amount. Dr Ng chimed in confirming that the test is around RM20,000, and is not covered by insurance.

As part of the campaign, TAW will be working with Roche to produce three different programmes targeted at making women understand insurance coverage so they can consider it more thoughtfully.

“We have a 99 per cent female audience so that’s very useful for getting this message out there. First, would be to put together and roll out a fun informative video that can start getting women to think about their insurance coverage,” said Lim.

“Because at the end of the day, after a long day at work and you come home, you’ve got the home stuff, as a woman the last thing you want is to have someone preach to you about what you have to do. So, that’s where we come in and we roll out the really fun videos to tell you and get you to start thinking”

Next, TAW will have an oncologist and insurance agent on its Real Chat programme on YouTube, which is a talk show hosted by Lim, to talk about treatment costing and to make people aware of the expenses involved for targeted therapy treatments.

“People think chemotherapy is expensive, they have no idea how expensive targeted therapy is. So, it’s crazy, it’s really unimaginable,” said Lim. “We’re going to have that conversation.”

Finally, TAW’s Real Chat programme will have an episode that features breast cancer survivors who will talk about their journey from diagnosis to cure. In this episode, Lim said audiences will get “to understand how insurance plays a pivotal role and to understand the challenges that they (breast cancer patients) actually had to go through to get to where they are today”.

What Women Should Ask Insurance Companies

In the meantime, Dr Ng had some tips on questions women should ask insurance providers when considering their policy. They should ask if the insurance will “cover all investigations?” he said. “This actually means, does it include the oncotherapy that is required before chemotherapy.”

He said women should also find out if the insurance will cover their chemotherapy as an outpatient, or do they have to be admitted to the hospital to undergo it.

Additionally, they should ask if reconstructive surgery and all the adjuvant hormone treatments will be covered by the insurance.

Adjuvant hormone treatments are hormonal therapy medicine given after surgery to lower the risk of the cancer returning.

Some patients will have to be on hormone therapy for 10 years, which can come up to a lot of money, said Dr Ng, so they should find out if the insurance will cover the treatment.  

Dr Ng said he hoped the HER Time Matters campaign will embolden women to speak up in their discussions with insurance providers and insist on having a package that suits their needs.

“Not we buy whatever package you have available. So, it needs to be suited for women at this moment in time.”

Expanding The Focus On Women’s Health

Although women now make up 50 per cent of the world’s population, most of the diseases that primarily affect women are underfunded, said Deepti Saraf, general manager of Roche Malaysia.

Deepti Saraf. Screenshot from launch of HER Time Matters campaign.

“If you look at the future pipeline of health care, only five per cent of that pipeline is focused on female conditions. So, clearly as a health care system, we need to do much more for women.”

Apart from the campaign, Deepti said Roche is also investing a substantial amount of its R&D on women’s cancers and other women’s health related initiatives. The pharmaceutical company has set up a new department that is fully focused on women’s health care.

“We’re also ensuring that our R&D, our clinical trials, include more women and we publish results that are gender specific. Because right now when results come out, they are one set of results whether it’s men or women,” said Deepti. “We do not know how drugs and treatments affect different genders differently, so we are looking at that aspect as well.”

For the campaign, Gleneagles Hospital, Sunway Medical Centre, and Beacon Hospital have come on board as partners, but Roche Malaysia is open to welcoming more health care providers as partners, Deepti said.

“We are partnering with LPPKN (National Population and Family Development Board) and that allows us to share on a broader scale, the infrastructure, availability for screening and diagnostics, with the larger population which includes the lower income and marginalised communities.”

Dr Wan Hilya Munira Mustapha, medical officer from the Human Reproduction Division at LPPKN, said the Board’s focus is on lower income households that they reach out to through a subsidy mammogram programme, which is free for those from the B40 group.  

Although the rate of health screenings in Malaysia is still at a low or moderate level, Dr Wan Hilya said it has risen over time. “LPPKN has been implementing this subsidy mammogram programme since 2007 and the screenings have been increasing in numbers.

“This year alone, we estimate about 25,000 women to have this free mammogram. And it is nearing our target number for the lower income households.

“So, you can see that awareness is coming up but we need to do more on this so that especially in rural areas, more women will come forward to do it.”

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