Ms B phoned her health insurer to say she was travelling to Australia the following day for her daughter Kaali's* treatment for her mood problems and restless legs. Doctors hadn’t been able to diagnose Kaali's problem, but Ms B thought it related to adrenal/thyroid issues. She asked whether the treatment would be covered by her policy. Ms B was told the insurer’s medical team would require a letter from a specialist recommending the overseas treatment and explaining why it wasn’t available in NZ. Ms B said her GP, not a specialist’s, had recommended she go to Australia, and she didn’t have time to get a specialist letter.
Ms B’s policy contained an overseas treatment allowance for investigations, tests and consultations if they: 1. are not available in NZ; 2. are recommended by a specialist; and 3. are approved by the insurer based on a medical report provided before the treatment takes place.
Ms B’s claim, for the overseas consultations and testing costs, was declined. Ms B hadn’t provided a specialist’s letter prior to treatment, and the treatment was available in NZ. The criteria had not been met. The insurer was entitled to decline the claim.
Complaint not upheld.