27 May 2022

‘Initial Cancer Diagnosis’ Gap Claims increased by more than 520% in 2021 compared with 2020

Submitted by Teresa Settas
‘Initial Cancer Diagnosis’ Gap Claims increased by more than 520% in 2021 compared with 2020

The pandemic has profoundly impacted early detection of chronic diseases and illnesses as people avoided - and continue to avoid - preventative health checks

An analysis of ‘Initial Cancer Diagnosis’ gap claims paid by Sirago Underwriting Managers during 2021 shows that the volume of claims increased by 528% in 2021, compared with 2020. Anecdotally, Sirago believes that the sharp increase in cancer-related claim statistics point to numerous reports showing that the pandemic has had  a profoundly negative impact on preventative healthcare and early  diagnoses of chronic diseases, including cancer.¹

Sirago Underwriting Managers, an Authorised Financial Services Provider, is a gap cover provider underwritten by GENRIC Insurance Company Limited, an Authorised Financial Services Provider and licensed non-life Insurer.

As part of the benefit package on certain options, Sirago’s ‘Initial Cancer Diagnosis’ benefit provides a lump sum of cash upon the initial diagnosis of malignant cancer. This benefit may be used to fund the costs of diagnostic investigations such as PET scans, MRIs, biopsy and blood tests which medical schemes may impose co-payments or sub-limits on, as well as immediate medication requirements while they are still registering their treatment plans with their medical schemes. This could cost members thousands of unbudgeted Rands upfront. 

“It was an expected trend that there would be less gap claims over the last 24 months, and particularly in 2020 given that medical scheme claims volumes were significantly lower as elective procedures and anything not related to COVID-19 or of an emergency nature was put on hold.  However, the big jump of a 528% increase in ‘initial cancer diagnosis’ gap claims in 2021 compared with 2020 is worrying in the sense that many of these cancer diagnoses are likely to be at much later stages – essentially deferred diagnoses. One of the key risks we identified was the knock-on effect that the pandemic would have on preventative and screening health checks, particularly for cancer, and what these delays mean in terms of prognoses for patients and the success and cost of such treatment,” explains Martin Rimmer, CEO of Sirago Underwriting Managers, a gap cover provider underwritten by GENRIC Insurance Company Limited.

To illustrate, in Q2 of 2020, at the height of the pandemic, Sirago processed just 11 ‘initial cancer diagnosis’ claims.  In the same period of 2021, that figure surged to 204.  The reality is that cancer did not go away, but rather, people were living with the symptoms and avoiding treatment due to concerns around COVID-19 infection. 

The direct and obvious consequence of the pandemic for cancer patients is the much greater risk of a more severe COVID-19 infection, given the debilitating impact that most cancer treatments have on the immune system.  However, the indirect consequences are onerous, and still being tallied – including delayed diagnosis, deferred tests, treatment delays, halted clinical trials, poor quality of life and mental health, worsening symptoms and the likely progression to more advanced cancer stages.  This has serious implications for the type of cancer treatment needed and the cost and even then, may still not be as successful if treated earlier. It’s also likely that more aggressive treatment used in later stage cancers will mean more complex side-effects and longer recovery. 

“A year can have significant implications for someone with a chronic illness, and a late diagnosis ultimately means more complex health interventions and more invasive, aggressive, costly and lengthy treatment and recovery time.  We’re already seeing the results of these delayed diagnoses now filtering through with a sharp uptick in large, mega gap claims related to chronic conditions – these are internally classified as claims of R50k and above for shortfalls not paid by medical schemes,” explains Rimmer.

Surviving the financial challenges

“The pandemic’s impact on access to healthcare, particularly preventative care, has been profound. And we’re not out the woods yet even as restrictions have been lifted – the delays in cancer diagnoses and backlogs in treatment procedures continues to persist and there is going to be a significant period of playing catch-up, as well as getting people back to their preventative and screening healthcare regimens.

“From an economic perspective, many people are also facing financial hardship as a direct result of the pandemic and are having to downgrade their medical scheme options during these tough times. This typically means a commensurate reduction in benefits, including for preventative care, health screenings, and possible reduced cover for cancer treatment.  Given the onerous financial burdens and significant out-of-pocket costs and shortfalls associated with cancer treatment, even with medical scheme benefits, there is now the added pressure of what a delayed cancer diagnosis and treatment adds to the mix – financially, mentally and emotionally,” says Rimmer.

The cost of funding cancer treatment can be a major debilitating factor, even if you are a member of a registered medical scheme. While medical schemes typically cover the cost of certain cancer treatments as a Prescribed Minimum Benefits (PMB’s), depending on what option you are on, your costs of treatment might not be covered in full and you could face onerous out of pocket expenses, co-payments and shortfalls.  Certain medical schemes might also only fund certain treatments partially like biologicals, if at all.  If it’s a matter of life and death and you need these treatments, some medical schemes will allow you to upgrade your option immediately, but in the instances where you are not able to upgrade and your medical scheme options does not allow for the appropriate cover, you could be forced to sacrifice your life savings or future financial security to gain access to these treatments.  

“A cancer diagnosis – at any stage - has a profound effect on your emotional, physical and mental wellbeing and typically impacts your whole family, livelihood and those around you. The pandemic has starkly highlighted the importance of proper healthcare financial planning - not only related to COVID-19 – but also the serious and unexpected knock-on effect it has on every aspect of our healthcare and financial planning. Take the time to meet with your financial planner and make sure that your healthcare funding plan such as medical scheme benefits and gap insurance work hand-in-glove to provide you with access to the best quality healthcare and treatment in order to mitigate as far as possible the need to delve into your monthly disposable income or life savings. This is unlikely to be the last pandemic we will face, and the importance of building a resilient healthcare plan that accounts for all the ripple effects of a health crisis has never been more critical,” concludes Rimmer.

For more information go to www.sirago.co.za

References:

Preventive Care Takes Pandemic Hit, Results in Missed Diagnoses

  1. Schmidt, H., 2021. Preventive Care Takes Pandemic Hit, Results in Missed Diagnoses. [online] Healthcare ExecIntelligence.

Available at: <https://healthcareexecintelligence.healthitanalytics.com/features/preventive-care-takes-pandemic-hit-results-in-missed-diagnoses> [Accessed 26 May 2022].

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Sirago Underwriting Managers (Pty) Ltd is an Authorised Financial Services Provider (FSP: 4710) underwritten by GENRIC Insurance Company Limited (FSP: 43638), an Authorised Financial Services Provider and licensed non-life insurer.

Terms and conditions apply, for more information visit www.sirago.co.za

Published in Health and Medicine