Laura Hannan, a 51-year-old freelance marketer from London, has been denied insurance coverage for her breast cancer treatment after following preventive care guidelines recommended by the National Health Service (NHS). Despite paying approximately £8,000 in premiums over two years for a private health insurance policy with WPA, which included comprehensive cancer coverage, she was informed that her claim related to her January diagnosis would not be covered.

Hannan, classified as “moderate risk” due to a family history of breast cancer, had undergone annual mammograms and taken tamoxifen—a medication prescribed by an NHS breast cancer family history unit at St Bartholomew’s Hospital—as preventive measures. WPA subsequently argued that these screenings and preventive medications constituted treatment, thus excluding her claim under the terms of their moratorium policy.

Moratorium policies, which make up about 82% of private health insurance plans in the UK, do not require full medical declarations at application and often exclude coverage for conditions that have required treatment, monitoring, or medication within five years before the policy start date. WPA’s position was that Hannan’s prior preventive treatments fell under these exclusions, and that she was at a higher than average risk, further justifying the refusal.

Hannan’s case has drawn attention due to the conflicting practices among insurers. While WPA declined coverage, major providers such as Bupa, Axa, and Vitality indicated they would cover treatment in comparable situations. Private insurance experts caution that moratorium policies offer less certainty about coverage, particularly for those with complex medical histories, and recommend independent advice when selecting a plan.

The Financial Ombudsman Service reviewed Hannan’s complaint and found that WPA had adhered to its stated terms, recognizing mammograms as treatment and tamoxifen as medication under the policy. However, the service did not assess the fairness of those terms. Hannan has contested this ruling.

Medical professionals at St Bartholomew’s have expressed concern about the broader implications of the insurer’s stance. The hospital’s breast cancer programme head has warned that denying coverage for preventive therapies could discourage at-risk patients from pursuing recommended screening and medication, potentially worsening outcomes.

Hannan estimates that, in addition to out-of-pocket expenses close to £6,000, she missed out on private care benefits such as nutritional support, customized wigs, and second opinions. Her reduced work capacity as a freelancer has further compounded financial strain. She has since removed cancer coverage from her policy but cannot change insurers due to her diagnosis being treated as a pre-existing condition.

WPA stated that its policies align with industry standards and were designed to protect all customers fairly, noting the challenges posed by covering individuals with elevated risks who receive preventive treatments. The insurer disputed claims that other providers would offer coverage under similar circumstances, citing adherence to guidelines from the Association of British Insurers.

Charities specializing in breast cancer prevention emphasized the importance of genetic screening and preventive medication, stating that such measures should be supported rather than penalized by insurance providers. The case highlights ongoing tensions between private insurers’ risk management practices and patient access to coverage for early detection and preventive health care.