My battle with lung cancer . . . AND my health insurer
Mrs L.H. writes: Last March, I was diagnosed with lung cancer though I have never smoked. I was admitted to hospital and advised by a consultant to use my health insurance to gain access to treatment not available on the National Health Service. I was matched to a biological drug to which I am responding well. But insurer Vitality Health has advised it will only cover this treatment for 12 months. It has also ‘de-recognised’ my consultant because he refused to cut his fees by half. I CAN only imagine the emotional rollercoaster ride of discovering you have lung cancer, then finding a consultant who offers a successful drug not normally available, only to have both drug and doctor snatched away by the insurance company that you relied on to finance both.
You even asked Vitality Health if it could provide a list of hospitals with a lung cancer specialist that the insurer would continue to recognise and finance. Its response was that it could not make any recommendations – which was not exactly what you had asked.
Your own enquiries have shown many insurers openly say they will not cover biological treatments for cancer, which you believe are the way forward.
Those that do often provide only limited cover even though you found the treatment was successful and offered hope.
I can understand no insurer wants to be held to ransom if a doctor’s fees suddenly rocket on the assumption that an insurance company must be a bottomless pit of money. But there is no evidence this is what happened, and Vitality Health did approve the course of treatment in the first place.
I asked the company to look into what you told me – and it did so promptly. A spokesman explained how Vitality sets its fees by studying the complexity, rarity and duration of medical conditions and treatments.
He added: ‘We recognise more than 22,000 consultants and it is rare we fail to reach agreement with any consultant. Where we cannot agree fees, we have to take a view as to whether we believe a continued commercial relationship is sustainable and fair on all the half a million members whose lives we insure.’
But he was honest enough to admit that Vitality unintentionally failed to take into account the lack of other specialist private consult- ants anywhere near you. Vitality has now reversed its decision. You will be treated by the same consultant as before. You will get the same drug for as long as the terms of your policy last. Vitality will meet the costs. You have told me: ‘This is great news and as you can imagine a huge weight has been lifted from the family.’
I am glad. I wish you all the luck in the world with the treatment.