Husband makes claim for obstetrics care for his wife’s pregnancy
The man said that it was “archaic” to view obstetrics care as limited to the person actually having the baby.
The man said that it was “archaic” to view obstetrics care as limited to the person actually having the baby.
When Katie* became pregnant, she and her husband Tim* arranged private obstetrics care which cost about $6,000.
Katie then made a claim on her health insurance and was paid $750. This was the total amount claimable under the obstetrics benefit in the policy she jointly held with her husband.
Her husband Tim then made a separate claim to the insurer, asking for the obstetrics benefit, providing a receipt for obstetrics care for Katie.
The insurer declined the claim, because Tim was not the person receiving the healthcare service.
Tim complained, saying that it was “archaic” to view obstetrics care as limited to the person actually having the baby. He brought the case to the IFSO Scheme.
Tim argued that obstetrics includes “advice, reassurance, expertise and suggestions that both parents receive”. The IFSO Scheme agreed, but said that, while Tim might be assisting Katie, unless Tim could show that he himself had received obstetrics care or services separate from Katie, he was not eligible to make a claim.
The law says it is up to the insured person to prove that they have suffered a loss and, here, Katie was the one who was having the baby and was at all appointments.
The IFSO Scheme found that the insurer had correctly declined the claim and was not required to cover obstetrics care for Tim.
Complaint not upheld
The law says it is up to the insured person to prove that they have suffered a loss. In the case of health insurance, only the person receiving a healthcare service can make a claim for associated costs.
*Names have been changed