Overseas treatment – no specialist letter, no cover

If you’re making a claim for overseas treatment, contact your insurer well in advance.

Overseas treatment – no specialist letter, no cover

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.

See the full case study.