Ms B had health insurance while she was studying in New Zealand. She was diagnosed with a significant depressive episode and made a claim to the insurer for the cost of $7,760 for a health pack provided by a gym.
The health pack included: 1 year’s nutritionist appointments; a nutrition programme; meals designed around Ms B being vegan; a supplementation programme; 4 personal training sessions; 12 months’ 3D Body Health Scans; and 1-year free membership at the gym.
The insurer declined the claim, on the basis that the health pack was “not considered to be reasonable treatment given by a doctor, nurse, hospital or physiotherapist and it [did] not meet the definition of an alternative medical provider.” Further, it said that the expenses were not considered to be reasonable medical expenses incurred to treat an injury or sickness.
Ms B complained that her doctor prescribed exercise as a treatment for her severe depression. She said the health pack was cheaper than other recommended treatment. Ms B provided an academic article and a letter from her doctor, in which the doctor recommended Ms B stay physically active and noted a gym/ supervised exercise programme would be beneficial, because it was difficult for Ms B to exercise outside in her non-study times.
The IFSO Scheme did not believe the cost of the health pack was a “reasonable” expense, “necessarily incurred”, because Ms B could exercise without incurring this cost.
The IFSO Scheme decided it was fair and reasonable for the insurer to rely on the terms and conditions of the policy in these circumstances.
Complaint not upheld
Consumers should read their policies to understand what cover is provided. Often, the IFSO Scheme receives complaints made by consumers who are disappointed, because they have expectations which cannot be met under the policy.