Back in February I rang my insurance company to ask if they would cover private chemotherapy costs. I was told by their representative that they would, at up to $60,000 per year. This they reconfirmed in another phone call I made to them in early April. Later in April I put in my formal application for pre-approval. I received no reply from Tower. I rang them in May and they said "no problem, your claim has been approved." My Avastin treatment began on April 20 and has continued for 3 more infusions. Then on my release from hospital on Friday I opened a letter from Aorangi private hospital in Palmerston North, the people doing the Avastin treatment, saying none of their bills had been paid. I rang Tower yesterday and was told "but it's been pre-approved-there should be no problem. We'll take this up with the claims department." In the afternoon I received a call from their representative to say that they wouldn't pay for the drug, the reason being that "it is not on the Pharmac schedule".
Now to those of you who are not New Zealanders, I need to explain. The Pharmac schedule is the list of drugs approved for full taxpayer funding via the public health system, in other words, all the drugs I can get for free. So my insurance company is telling me they will only pay for drugs that I can get for free from the public health system.
I have now obtained a copy of the policy, and the section (3) detailing medical benefit is a bit ambiguous. But sure enough, in the fine print, under exclusions on page 25, are any drugs not on the Pharmac schedule.
So yes, they are covered by the fine print, but in terms of misleading their customers by implying a benefit which simply does not exist, an
d by telling them so over the phone before they undertake treatment, this company has achieved doublespeak of Orwellian proportions.If you are a New Zealander, be very wary of this insurance company.
Reminds me of the Monty Python Insurance sketch..
ReplyDeletehttp://www.youtube.com/watch?v=kO2R_DDZPCM
I would go to the newspapers with this!
ReplyDeleteThanks Ed. Yes, I will. but at a time and venue of my choosing. I have also "as a courtesy", told the Insurance company senior management a little of my media profile, and that I will certainly telling this story through some suitable outlet in the future. I invited them to consider how they would answer a reporter who asked them, "so let's get this clear. You will only pay for drugs that your customers can get for free?".
ReplyDeleteTower have "invited me to appeal in writing". This I will certainly do. But it turns out that in NZ we have someone called the "Insurance Ombudsman" with legal powers. If I am turned down by Tower I can appeal to the Ombudsman, who will demand from Tower written transcripts of all our phone conversations. This will cost Tower dearly in process time and senior management time. My job now is to inflict as much financial cost as I can on these people, within the framework of the law. But yes, I am thinking of doing a Kim Hill show update on my cancer, which is turning out to be a remarkable story in so many ways, not the least of which is the apparent efficacy of the Avastin, which Pharmac won't fund. There is whole heap of public interest stuff here and I might as well try to do some good for my cancer comrades.
You only go to Newspaper and TV show after having exhausted all other avenues.
ReplyDeleteAgreed Yang-it's the "nuclear option".
ReplyDelete