Feature: S. Korean cancer patients in battle against insurer over treatment coverage

Source: Xinhua| 2021-05-14 13:18:52|Editor: huaxia
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by Yoo Seungki

SEOUL, May 14 (Xinhua) -- Four South Korean women, who have yet to fully recover from cancer, have been in a battle against their insurance company for over a year as the company refused to cover treatment at nursing hospitals, which the insurer believed not to be a "direct treatment of cancer."

In January 2020, tens of policyholders, who had been denied coverage, thronged into the customer services center on the second floor of Samsung Life Insurance headquarters in southern Seoul, demanding the payment and a meeting with officials in charge.

Samsung Life decided in February to shut down the center, where over 30 policyholders suffering from cancer were placed.

It was less than a month that the number dropped to 11 and it eventually declined to four, with some receiving the unsettled insurance claims completely or partially after years of fight against the insurer, and the others leaving the center because of their failing health.

"We put our lives on the line for the battle. We're fighting against cancer, fighting with Samsung Life, and also in a legal fight (involved in the fight against Samsung Life). Our battle is threefold," Kim Kuna, one of the remaining four at the center, said in an interview with Xinhua.

The interview was conducted over phone as Kim, the 59-year-old mother of a son, along with three other women aged between 55 and 67, have stayed at the center for almost 500 days.

"We'll never leave before getting the insurance claims we're entitled to. We were also sued by Samsung Life demanding over 600 million won (530,000 U.S. dollars) in damages," she said.

Samsung Life said in a written statement to Xinhua that it had consistently called on the women to immediately stop the "illegal occupation" and come to an "amicable settlement" via dialogue, calling the damages suit a "minimum legal action" it can take to be compensated for the customer services center's shutdown and relocation.

It noted that some of the members of the Gathering of Cancer Patients to Fight against Insurance Companies (GCPF) launched a stay-in protest rally without notice at the center, which drove the insurer to close it down, as their acts such as making noise and disturbance were so severe that it could not maintain the customer services.

Asked about the definition of the direct cancer treatment, which Samsung Life sees as a key criterion of cancer care coverage, the insurer said it refers to the treatment that removes cancer, suppresses the propagation of cancer and improves grave pathological symptoms, "directly" manifested by cancer.

The treatment for after-effects and complications, developed after a cancer treatment, does not represent the direct treatment of cancer according to judicial precedents and the financial watchdog's definition, which the insurer also followed, Samsung Life said.

"The division into direct and indirect treatments is not the medical division ... (The conflict) is just about a matter of contractual relationship between an insurance company and policyholders based on insurance terms," Jeong Hyung-jun, director of policy committee at the Korean Federation Medical Activist Groups for Health Rights, told Xinhua.

The physiatrist said the medical criteria relevant to insurance terms should have fallen within the jurisdiction of the health ministry, not the financial watchdog, noting that it resulted in the "unscientific terms."

The country's top court ruled in favor of insurers in 2013, saying treatment at nursing hospitals does not represent the direct treatment of cancer. It was reversed in 2016 by the Supreme Court, which ruled that if it is indispensable for anti-cancer chemotherapy, it makes sense to see the treatment at nursing hospitals to strengthen immunity and cure after-effects as the direct treatment of cancer.

"Cancer insurance is a private contract between an insurer and policyholders, so the insurer should cover cancer treatment in accordance with the contract. The judicial rulings are different depending on cases. If Samsung Life followed the precedents, I should have received money according to the 2016 ruling," said Kim, the GCPF co-head.

Kim worked as an insurance agent for the country's biggest life insurer for seven years in the 1990s. At that time she had enough confidence in her own company to buy three cancer insurances from Samsung Life but she never imagined the denial of coverage.

After undergoing surgery at the Seoul National University Hospital in 2015, Kim was sent to a nursing hospital near Seoul, as it was impossible to commute from her home in Daegu, about 300 km southeast of Seoul, while undergoing about 30 rounds of radiotherapy and tens of days of chemotherapy.

However, her repeated appeals for the coverage of nursing hospital bills were rejected even though her doctor at the hospital issued an official note recommending the need for treatment at the long-term care facility.

According to the note sent to Xinhua by another of the remaining four women at the custom services center, her primary doctor at a general hospital recommended the treatment at a nursing hospital, but she was also denied coverage by Samsung Life.

Amid a growing number of conflicts between insurers and policyholders, the financial watchdog recommended the coverage of hospitalization charges in September 2018 and issued an institutional warning against Samsung Life in December last year.

According to the Financial Supervisory Service (FSS) data submitted to Kim Jong-seok, a former lawmaker of People Power Party, Samsung Life fully accepted 62.8 percent of the cancer care coverage recommendations made by the financial watchdog. It was sharply up from 27.2 percent tallied in the previous year, but it was far lower than over 90 percent for the second- and third-biggest life insurers and 100 percent for the remaining 15.

Cancer insurances boomed here in the 1990s, when insurers designed products having little in mind over risks such as the proliferation of nursing hospitals and the development in medical technology that raised the survival rate of cancer patients. Demand mounted for cancer care coverage since 2000, leading to higher conflicts between insurers and policyholders, according to Kim Deuk-eui, chief of the Korea Financial Justice Solidarity, a non-governmental organization.

"From the perspective of Samsung Life, the (FSS) coverage recommendation is not mandatory. Furthermore, it (Samsung Life) seems to believe that disadvantage from the increased future cost for insurance claims is bigger than the (FSS) institutional warning," the civic activist told Xinhua.

"We're in the life-and-death battle (against Samsung Life)... Despite the danger, we come here for the sake of our families and friends as well as tens of millions of policyholders who can face the same troubles as ours," Lee Yang-lee, the GCPF co-head, told Xinhua.

The interview with Lee, who was also denied coverage for nursing hospital bills, occurred inside a shipping container standing beside the Samsung Life headquarters. The 59-year-old said her fellow policyholders had gathered there twice a week for the protest rally since September 2019. Enditem