An alarming number of cancer patients, particularly seniors, are finding their insurance guarantee letters (GL) declined even after an initial approval. This growing trend is financially devastating, especially for elderly cancer patients who face staggering medical costs often exceeding their retirement savings. Top private hospital executives and healthcare advocates alike confirm this troubling trend, which leaves patients in an additional precarious position: forced to pay for treatment out-of-pocket beyond their means with no guarantee of reimbursement.
At KALSIS, while we are neither an insurer or healthcare practitioner, we specialise in financing solutions for elderly cancer patients facing such hardships. Here’s a list to help seniors and their families understand why this happens—and learn what steps they can take when it does.
1. Important to know the limits of medical insurance policies
Recent media reports spotlight a disturbing reality: cancer patients across Malaysia are being denied the financial coverage they thought was secured through their insurance policies. Here are some recent highlights:
• City Cancer Challenge discusses how insured patients in Malaysia are still left without adequate coverage for cancer treatments and related medical expenses, leaving them struggling with enormous out-of-pocket expenses City Cancer Challenge.
• The Star reported on a landmark case where a cancer patient successfully sued an insurance company after submission of coverage was wrongfully denied, one of many alarming examples The Star.
• Code Blue highlights a report criticising insurers’ tendency to reject payable claims, especially under schemes like MySalam, aimed at supporting Malaysians through critical and specified illnesses Code Blue.
• The Sun covered a viral case where a woman’s husband was left with RM19,000 in unpaid surgical bills despite previous years of regular premium payments as a policy holder The Sun.
2. What the Ombudsman for Financial Services (OFS) Says
The OFS has seen countless cases where insurance claims are denied due to misunderstandings or omissions of key details by policyholders. Key insights include:
• Lack of Understanding: Many policyholders believe they are automatically covered once diagnosed with a critical illness like cancer, without realising the conditions attached to their policies. Misinterpretations of exclusions can lead to denied claims if policyholders overlook essential requirements e.g proof from a specialist for certain diagnoses.
• Non-disclosure of Medical History: Insurance claims can be denied if applicants fail to declare their complete and prior medical history in their supporting documents, as insurers rely on this available data to review risks and determine premiums.
• Agent Misrepresentation: Unfortunately, many policyholders only discover their policy’s limitations after submitting a claim, often because agents incorrectly presented the policy’s benefits.
Understanding these nuances can help policyholders avoid some of these general pitfalls and make more informed choices when applying for, renewing or changing policies.
3. Our observations on why approved Cancer Insurance Guarantee Letters get declined
From our interactions with seniors, we see two critical challenges in Malaysia’s current insurance landscape:
• Old Insurance Models: Many insurance policies were crafted decades ago and haven’t evolved to cover outpatient day treatments including immunotherapy or targeted therapies, which have become the standard in modern cancer care and may not be stated in the policy contract. As a result, policies may not address the needs of today’s cancer patients, who often don’t require in-patient admission but face steep outpatient costs.
• High Rates of Underlying Health Conditions: Malaysia has a high incidence of non-communicable diseases (NCDs) such as diabetes and hypertension, which can complicate insurance approvals. Swiss Re’s studies indicate a link between metabolic conditions and cancer, increasing the likelihood of disputes over claim eligibility for cancer treatments. When combined with inadequate policy terms, these health issues further increase the financial vulnerability of seniors with acute pre-existing conditions seeking treatment.
4. What to Do If Your GL Gets Declined: Consider KALSIS
If you or a loved one is facing a denial of insurance coverage for cancer treatment, KALSIS in an option to consider. Designed to provide immediate and sustainable relief, KALSIS empowers seniors to continue treatment without liquidating savings or going into debt.
Eligibility: Please note to qualify for KALSIS, seniors must be 65 or older, own a fully-paid, freehold and landed home in the Klang Valley, and be undergoing cancer treatment. KALSIS provides financial resilience by turning home equity into cash to pay for healthcare needs. The scheme delivers lump-sum payouts in the first year, followed by monthly annuities across the duration of their lives, so seniors are able to cover healthcare costs while staying in their own homes for life.
5. No One Should Have to Stop Treatment—KALSIS Can Help
Cancer treatment is costly, however no senior should be forced to forgo it due to insurance disputes or limited coverage. At KALSIS, we believe in enabling seniors to focus on healing rather than financial stress. By providing immediate funds and long-term financial resilience, KALSIS ensures that important treatments don’t have to stop and bills get paid, thus giving cancer patients the best chance to overcome their illness.
For more information, please contact us through our website or reach out via WhatsApp at +6011 5638 8580. We are here to offer applicable seniors peace of mind, financial support, and hope for the future.