Views & Reviews Personal View

Patients with melanoma are avoiding follow-up to get insurance

BMJ 2012; 345 doi: (Published 03 December 2012) Cite this as: BMJ 2012;345:e7803

Re: Patients with melanoma are avoiding follow-up to get insurance

The problem as described over insurance for those patients with melanoma is the tip of a very big iceberg. In general there are pressures not to give the downside of medical treatments – witness the recent controversies over the information provided about breast screening. Any patient having investigations or being screened for a variety of serious diseases may fall into a grey area and should understand at the outset that this could affect their insurance prospects if follow-up by a specialist unit is recommended.

Where a disease has occurred, a simple solution is not to arrange unnecessary follow-up – just why some of these low-risk patients should have routine specialist follow-up is unclear - and to allow re-referral when and as necessary. The usual compromise position is that any disorder arising from or related to the underlying disorder is excluded from the insurance, but may be included on the payment of a higher premium. For new private health insurance it is much more likely the disorder will be excluded altogether.

Nor can we really expect insurance companies to keep pace with all the changes in the classification of diseases. The inclusion of less serious melanomas along with the more serious may be good for publicity but this response of the insurance companies is a hidden cost which could have been foreseen. For those of us faced with higher premiums based on age the answer has been to shop around and not to expect an absolute right to travel, with other members of the public paying the bill if things go wrong.

Competing interests: No competing interests

07 December 2012
Simon Kenwright
Rtd physician
East Kent
Ashford, Kent TN25 6BD