[뉴스토마토 권유승 기자] The controversy over whether inpatient treatment in a nursing hospital is the reason for cancer insurance coverage is continuing. It is argued that the judgment should be made according to individual issues such as the patient’s condition rather than a uniform conclusion.
On the 7th, a research fellow at the Insurance Research Institute Baek Hwa-sa said in a report on’Review of the dispute on hospital admission fees for nursing hospitals’, saying, “There has been a dispute over the hospital stay in nursing hospitals in relation to cancer insurance products in recent years.
According to the report, disputes have arisen between consumers and insurance companies as to whether a patient admitted to a nursing hospital during or after cancer treatment is a case of admission for the direct purpose of cancer treatment.
Since admission to a nursing hospital can be viewed as an extension of cancer treatment, the position that admission to a nursing hospital for strengthening immunity is not considered a direct purpose of cancer treatment was opposed. .
According to the terms and conditions of cancer insurance products that cover cancer hospitalization costs, not all hospitalizations that are even slightly related to cancer are covered by insurance. If the insured person is diagnosed with cancer after the start date of cancer coverage and is hospitalized for the direct purpose of treating the cancer, it is the reason for the insurance payment.
As to whether hospitalization in a nursing hospital corresponds to hospitalization for the direct purpose of cancer treatment, precedents and dispute mediation cases provide a principle standard.
The court admitted that’in order to eliminate cancer or to inhibit cancer growth’ and’in order to ameliorate serious pathological symptoms directly manifested by cancer itself or cancer growth’ was for the direct purpose of cancer treatment. However, it was not recognized as the direct purpose of cancer treatment in the case of’to alleviate the sequelae or treat complications caused by cancer or cancer treatment’.
In the case of dispute settlement by the Financial Supervisory Service, hospitalization for the direct purpose of cancer treatment was interpreted as the same meaning as hospitalization necessary for cancer treatment. As with the court’s position, it was difficult to admit it as a cancer treatment in the case of medical treatment that is hospitalized for recovery of health or simply treating the aftereffects or complications that occurred after cancer treatment.
However, if it is indispensable to receive chemotherapy, which is scheduled to be hospitalized to recover physical function and to treat the sequelae caused by the previous chemotherapy while the same chemotherapy continues for a certain period of time, hospitalization for cancer treatment It is a view that corresponds to.
Researcher Baek said, “If you are hospitalized for the purpose of treating cancer or recovering health, it is difficult to be admitted to a nursing hospital while cancer treatment is continuing.” In the event that strengthening immunity and treating sequelae are indispensable for continuing cancer treatment in the future, hospitalization in the relevant nursing hospital would also correspond to hospitalization for the treatment of cancer.”
“However, even in this case, it is not a simple or clear matter to determine whether inpatient treatment in a nursing hospital is indispensable for the cancer treatment that will continue in the future.” It is suggested that you have to judge according to specific facts such as cognition, treatment contents and methods in nursing hospitals, opinions of doctors, etc.”
Whether immunity therapy is for direct cancer treatment purposes. Pyo/Insurance Researcher
Reporter Kwon Yoo-seung [email protected]
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