MOH WILL REVIEW MEDISHIELD LIFE COVERAGE FOR PROPHYLACTIC MASTECTOMY

We thank Dr Tan Yia Swam for her letter “Insurance agents asking doctors to change codes to ensure claims go through” (April 17), on insurance coverage for prophylactic mastectomy in breast cancer patients with pathogenic gene mutations such as the BRCA gene mutation.

In general, MediShield Life does not cover primary prevention, which refers to medical services for generally healthy individuals to prevent diseases, such as screening tests and vaccinations.

This is because MediShield Life as a national insurance scheme is focused on protecting individuals when they receive medically necessary treatments for illness or injury. This keeps premiums affordable for policyholders. 

However, with advances in medical science, the line between preventive and diagnostic care is increasingly nuanced, particularly in cases involving genetic predisposition to serious conditions like breast cancer.

Extending MediShield Life coverage for both genetic testing and subsequent preventive interventions needs careful study, as any policy changes can have broad implications and impact on premiums for everyone. The Ministry of Health is therefore reviewing and will issue claim rules to guide practitioners on breast-related surgical claims later this year.

We agree fully with Dr Tan that medical professionals should not misrepresent or be pressured to misrepresent medical codes for claims, including those under government schemes and insurance.

Medical professionals who encounter situations where they disagree with the advice given by insurance agents to their patients should report these cases to the insurers for follow-up investigation and appropriate disciplinary action where misconduct is established.

Lydia Loh
Group Director, Healthcare Finance Group
Ministry of Health