3 weeks ago
Insurance Gap Leaves Cancer Patients Paying Most Treatment Costs
A grandmother named Kanchan got very sick with breast cancer.
Her family had bought health insurance, which is money you pay to a company that promises to help pay doctor and hospital bills.
But when Kanchan needed treatment for five years, the insurance paid only a small part of the bills.
The family had to pay most of the cost using their own savings.
The insurance company also changed its rules without telling them, so it paid even less in later years.
Some very expensive medicines, costing ₹2.5 lakh for just one dose, were not covered at all.
Doctors say many cancer patients face the same problem.
They believe insurance companies should be kinder and clearer about what they cover.
Experts say new rules are needed so insurance actually helps sick people instead of making them fight over paperwork.
Kanchan Pande, 64, was treated for breast cancer over five years at a private Delhi hospital, involving chemotherapy, radiation and 78 hospital admissions.
Despite holding a ₹5 lakh health insurance policy, the family paid 70–75 per cent of treatment costs out of pocket.
Balaji Pande alleges the insurer changed policy terms from the second year without informing the family, cutting chemotherapy coverage to roughly ₹50,000–55,000 per year.
Nine chemotherapy doses bought at ₹2.5 lakh each and radiation therapy were not covered by the insurance policy.
Doctors say policy exclusions, reimbursement caps, costly next-generation medicines and claim delays force many insured cancer patients into significant out-of-pocket spending.
- Who
- Kanchan Pande (64), a breast cancer patient, her husband Balaji Pande, and doctors Dr Atul Sharma and Dr Abhik Chattopadhyay.
- What
- The Pande family paid 70–75 per cent of cancer treatment costs out of pocket despite holding a ₹5 lakh health insurance policy, which the family says did not cover many key treatments.
- Where
- Delhi, India, where Kanchan was treated at a private hospital; expert commentary came from doctors in Delhi and Kolkata.
- When
- Over a five-year treatment period; the article was published on August 10, 2026.
- Why
- Policy exclusions, reimbursement caps, changed policy terms, and the high cost of next-generation cancer therapies left most treatment expenses uncovered by insurance.
Patients and Doctors
Insurance Companies
Coverage of newer cancer therapies
Patients and Doctors
Doctors say next-generation therapies such as targeted therapy, oral chemotherapy and immunotherapy should be covered, and that classifying them differently under policy terms leads to disputes and delays.
Insurance Companies
As described by doctors, insurers question claims based on a patient's family history of cancer and classify newer therapies differently, limiting or denying coverage under policy terms.
Cashless facility vs. pay-first reimbursement
Patients and Doctors
Doctors argue patients need a more humane, patient-centric approach with cashless treatment instead of being forced to fight over technicalities and fine print.
Insurance Companies
Patients are often required to pay for treatment first and seek reimbursement later, with private insurers imposing sub-limits on room rent and other expenses that reduce final reimbursement.
Transparency of policy changes
Patients and Doctors
Balaji Pande alleges the insurance company changed its policy from the second year without informing him, cutting chemotherapy coverage from ₹5 lakh to about ₹50,000 per year.
Insurance Companies
A Delhi-based insurance agent says that when patients do not read the minute details of a policy, the ombudsman resolves such cases, but most patients are unable to fight their case due to poor health.
Key facts
- Patient
- Kanchan Pande, 64, breast cancer
- Insurance policy
- ₹5 lakh health cover
- Out-of-pocket share
- 70–75% of treatment cost
- First treatment cycle cost
- ~₹6.2 lakh, with ~₹5 lakh covered by insurance
- Hospital admissions
- 78 admissions, each costing about ₹24,000
- Uncovered chemo doses
- 9 doses at ₹2.5 lakh per dose
- Annual chemotherapy coverage
- Dropped to about ₹50,000–55,000 per year
- Government scheme (PM-JAY)
- Provides health cover up to ₹5 lakh annually
Quotes
Dr. Atul Sharma
Vice‑Chairman, Medical Oncology, Max Super Speciality Hospital, Saket
“Patients need a more humane approach. Insurance should support them during serious illnesses rather than forcing them to fight over technicalities and the fine print.”
thehindubusinessline.com
“We had insurance, but it did not help as expected.”
thehindubusinessline.com
Sources
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