Why NiB’s Private Health Cover has to change

This is a guest post written by my partner, Jen Tsen.

On 25 January, I found out that my fiancé had breast cancer. There are all kinds of heartbreak a person experiences when they find out someone close to them has this disease. This goes double-fold when it is the person you love most in the world.

There are some ways that we have been blessed. Throughout the last two months we have had family and friends who have reached out to us; to comfort and reassure us. This was not the case with our Australian health insurer NiB.

At a time we needed health insurance the most, NiB not only refused to provide us coverage, but refused to provide financial options and even straightforward advice. In the few awkward instances NiB representatives made contact, they made things worse. NiB have made my fiancé’s cancer journey more difficult, and more dangerous.

The NiB cancer rollercoaster

So to start with, we signed up with NiB on 25 October 2014 under their Basic Hospital and Core and Wellbeing plan, paying over $2,600 per annum. At the time we joined, the NiB insurance advisor told us we would get hospital cover, but did not tell us that we would not be insured for any type of cancer.NiB also did not explain that our ‘Basic Hospital’ coverage did not include any treatment related to cancer surgery, including surgery that the public health system describes as urgent (Category 1).

The language in the contract (sent to me after we signed on) is a mess of confusion. While it lists what is covered and not covered, there is no place that specifically refers to cancer. When we called to ask NiB about hospital cover in January, we were told they could not cover us because this fell under ‘Other Services’. This was a blow. When else would we find out any service was not covered, except when we needed to ask because it was a treatment we would need?

Leading up to this point, our GP had recommended that my fiancé undertake tests at a well-known multidisciplinary breast clinic, and after diagnosis we decided that we would go with their private surgeon to get her into recovery as quickly as possible. The pathology had indicated that the cancer was fast growing and was on the point of tipping from early to secondary breast cancer. Our medical friends advised us that the biggest benefit of private insurance was at this exact point, to beat the waiting list and get the surgeon of our choice.

We understood that many of the long-term costs of treatment might not be covered by NiB, but we assumed that ‘basic hospital cover’ meant exactly that. We assumed that NiB would at least be able to compensate us for some of the surgery’s incidental costs, such as in relation to the use of the hospital theatre, or accommodation for the two nights, if not the surgeon’s bill.

Any assistance with these expenses would have helped us during this difficult period – we paid $7,131.20 for these three alone. However, not only was there no assistance from NiB, by increasing our cover to the ‘standard hospital’ plan NiB said we would have to wait another twelve months for future cancer cover to kick in. To top it off, NiB refused to even provide us a preconditions form to take to our doctors, and we were provided no incentive (like a shorter waiting period or a lower premium) to stay with them. We would have to pay all costs for 12 months before the extended cover could begin.

Why cancer surgery should be covered by all ‘Basic Hospital’ cover

So in my view there are a range of important reasons why NiB’s approach to cancer is wrong.

The first reason is obvious. The language in the contract itself is dishonest. Using a clause like ‘Other Services’ to hide the lack of cover for cancer is unethical. Expecting that customers will ask about specific treatments that may fall under ‘Other Services’ before they actually need them is unlikely to ever happen.

The second reason is that ‘Basic Hospital’ is surely meant to apply to hospital treatment that is urgent and necessary to save a person’s life. Is it sensible to make a difference between surgery to mend a broken arm or remove a tumor? My fiancé’s cancer surgery was a Category 1 in terms of urgency for elective surgery. ‘Elective’ does not mean that treatment is optional. Category 1 elective surgery actually means that if surgery is not done within four weeks, the medical condition will become an emergency.

The third reason is that the exclusion of some urgent hospital treatments and not others is arbitrary, confusing and different from other parts of the Australian health care system, such as the Medicare Safety Net Threshold where hospital and out-of-hospital services means exactly that. If you came from another insurance provider (like we did) you may not even expect that this difference in coverage might exist. In fact, other health insurers cover cancer surgery in their basic hospital plan, like the health insurer we are leaving NiB for.

Finally and most importantly, excluding specific references to cancer in the basic hospital cover indicates that NiB is denying the scope and incidence of this disease. Cancer Australia tell us that by the age of 85 years, 1 in 3 women will be diagnosed with cancer, and 1 in 2 men. Since the late 1980s the incidence of cancer has continued to climb. In 2015, 126,800 new cases of cancer were diagnosed in Australia.

We understand that NiB is more popular with younger Australians, and NiB’s marketing is intended to target us. But whatever your age, the reason anyone ultimately gets health insurance is for the insurer to come to our aid when something unpredictable happens. And with cancer, the chances of this happening, is unfortunately way too high.

A cancer diagnosis is not an add-on to the health risks everyday Australians face. How can our society recognise cancer as common, for instance, annually holding a national test cricket match to raise awareness about just one kind of cancer, or organise fun runs in every major city, but NiB is still able to leverage against other health insurers by not covering any component of the urgent surgery costs related to this endemic disease?

Who do you turn to when you find out your fiancé has cancer?

I’m sure it can’t be easy working for a health insurance company, especially when you have to be the bearer of bad news. But it is reasonable for members to be assured that NiB staff are well trained, and that when they need to get in contact about serious health issues, they can do so with sensitivity.

I’ve had three phone conversations with NiB. I had these conversations because I didn’t want to allow my fiancé to get upset. She wasn’t, but in the end I was. After the second conversation I was so angry and hurt that I cried.

The first call was when I asked about our plan and was told it did not cover hospital services relating to cancer surgery. NiB told me they would send me a precondition form. I was later advised by email that a supervisor decided not to send this. The second phone call informed me why I had not been sent a precondition form. During the call NiB declined to answer my questions around the contract and the representative actually told me we should go through the public system for cancer, like she had. On the third call NiB asked me why I had decided to leave. The person hadn’t read our file. The NiB representative wrongly informed me that my new provider would charge us an excess for every hospital trip we made. I also found out from my new provider afterwards that this person had cancelled our cover early, so that we would be left with over a month without any health plan. What if something happened to my fiancé or me during this time? We would have had to pay. This act also endangered our ability to get the same premium of health cover under our new provider. From NiB’s perspective, they would have profited a few hundred dollars because we had paid premium the year before.

A lot of the issues I am writing about are ones I wrote to NiB over a month ago. After the first phone call, I wrote back a long email asking to talk to an NiB representative about my concerns with the contract and NiB’s approach to cancer treatment. I have not heard from NiB on any of these matters by phone or email, and my only recourse is now to talk to Consumer Affairs.

On 1 March, after Amanda’s mastectomy and a positive recovery, I found out that her original prognosis had changed. They found a tiny metastised cancer in the T12 vertebrae of her spine. It is funny that such a small thing, a 9mm growth embedded in the middle of the bone, could mean so much, but it has turned our world upside down, for the second time. This was also exactly why the surgery she undertook was urgent.

I believe NiB should not be allowed to provide insurance that provides ‘Basic Hospital’ cover that excludes urgent cancer surgery. If I had a chance to talk to NiB’s spokesperson and brand ambassador, Paul ‘The Chief’ Harragon, I would ask him to end his association with NiB.

I know that my views come from a deeply personal place, but it is hard for me to see how he, as a State of Origin great and as a father and husband, could look at my experience and not think that things at NiB were fundamentally wrong. Especially as I know he is a champion for brain cancer treatment through the Mark Hughes Foundation.

It is a big call, but in so many ways, NiB has let us down. I just hope that this story is told so that others won’t be let down, too.

Jen Tsen.

Holding My Breath

Last week, it was confirmed that I have a small cancer in my T12 vertebrae.

This changes everything. My primary (or early) breast cancer is now classed as secondary (or advanced) and as such, it is no longer curable. Instead, the plan will be to slow down it’s growth and stop it from spreading.

These are just words and I don’t yet know what they will mean for my health – this year, next year or the ones after that. I have been told that instead of chemotherapy, the treatment is now hormonal therapy. This sounds much milder, but it may be ongoing. Until I start the treatment, the doctors can’t tell me what to expect from it. Everybody’s body is different.

For me the greatest challenge with this news is to accept that I no longer have any certainty of the future or of my health. I may not know how I will feel today, tomorrow or next week – emotionally or physically.

I will need support from my partner, my family and my friends. For someone who likes to do things for myself, this is really hard, but I am learning.

I know I will be in your thoughts and that lots of good vibes are coming my way. I might need to bottle them and save them up for another day.