Insurance woes – is your health really covered?

In 2002 I took out an insurance policy with Southern Cross. It was a fairly high premium for Wellness B but I knew with my crazy family history that I needed to protect myself from a young age (I was 22). I signed the paperwork for ‘unlimited surgical cover’ and it certainly helped me sleep better at night, knowing I had this level of protection when it came to surgeries and future health hiccups.

I’m now 38 years old and I found out I had BRCA nearly 3 years ago. During that same year Southern Cross set a new clause to policies – a $40,000 limit for preventative surgeries. I was shocked they would do this for 2 reasons – firstly because the amount of $40,000 covers only 1 surgery and BRCA’s generally need 2 – 4 surgeries, and secondly because with BRCA we have an extremely high chance of developing cancer, sometimes nearly 80%, so the surgeries are in many cases necessary for the people living with the BRCA gene. But the view of Southern Cross seems to be – they would rather wait until the cancer has arrived (not to mention your life is in danger!) and pay out a much higher amount at that stage –  and chemotherapy, radiation is certainly not cheap.

Right now as I type I should be in hospital recovering form my oophorectomy (ovaries removal). No one can tell me definitively whether there is cancer in my ovaries right now, just that the chance is high and “we will know when we’ve removed them”. I have considerable pain in my ovaries, which is from enlarged cysts in my ovaries – PCOS Syndrome. This is not a great indicator to my ovary health. Compounding this is a history of ovarian cancer in my family.

So when Southern Cross cancelled my operation 6 days before it was scheduled, I was left feeling pretty low. They called me and said ‘we can see why this is a necessary operation for you, but your policy won’t cover it.” and that was that.

I have very real fears about what will happen if my ovaries are not removed soon and I am now on a waiting list in public.

A big thanks to journalist Melanie Earley and BRCA carrier Susan Mahon for putting this story together with me.

You can read it here…


Mum told six days before ovarian surgery that insurance won’t cover it

By Melanie Earley

Just six days before Auckland mum Anna Jobsz was due to have her ovaries removed she was told her insurer wouldn’t pay.

Now the mother-of-one and PR professional must fork out $15,000 for private fees or postpone the potentially life-saving surgery.

Jobsz, 38, has the BRCA2 gene which dramatically increased her chances of getting breast or ovarian cancer.

Anna Jobsz plans to have her ovaries removed after being diagnosed with the BRCA gene, which causes a higher risk of ovarian cancer.
CHRIS MCKEEN
Anna Jobsz plans to have her ovaries removed after being diagnosed with the BRCA gene, which causes a higher risk of ovarian cancer.

She already underwent a double mastectomy in 2016, and now wanted her ovaries removed as a preventative measure.

“They don’t know whether there’s cancer in my ovaries right now,” Jobsz said.

“Before my mastectomy they could tell me I was cancer-free but with ovarian cancer they can’t.”

However, her latest operation has been declined because the double mastectomy pushed her over the claim limit of $40,000 for preventative operations.

Jobsz has been insured with Southern Cross Insurance since 2001, with a $120 monthly premium. The plan originally provided unlimited surgical treatment for cancer.

In 2016 Southern Cross created the cap of between $30,000 and $50,000 per lifetime, depending on the member’s plan, for preventative operations.

The surgery to remove her ovaries was deemed “preventative” because it was not known if she had cancer of her ovaries.

“Anyone with BRCA requires more than one operation, so that amount covers hardly anything,” Jobsz said.

“I signed my policy in early 2000’s for unlimited surgical cover and I’ve been paying the full amount on my policy for many years. Their new rules don’t seem fair.”

Without insurance, Jobsz could not afford the $15,000 surgery and would have to go public. This could take up to a year.

“There’s no backstop for me, it’s a horrible position to be in, they’re asking me to prove I have cancer in my ovaries.”

Jobsz has already had a double mastectomy.
ANNA JOBSZ/INSTAGRAM
Jobsz has already had a double mastectomy.

​Jobsz said she spent a lot of time worrying about her son, who recently turned five, and what his future would look like.

“I worry about it all the time, I need to be here to take care of him.

“It’s something I think about every night before I go to sleep.”

Her doctor submitted her insurance claim form about three weeks ago, but the cover was declined less than a week before the surgery, she said.

Jobsz with her five-year-old son, Carlo.
ANNA JOBSZ
Jobsz with her five-year-old son, Carlo.

Southern Cross Health Society chief marketing officer Chris Watney said he was aware Jobsz’s claim had been declined.

“The Society recognised the wish for members to have access to surgeries to prevent the development of cancer in people at high risk of developing the disease,” he said.

“The allowance is not intended to cover the full cost of multiple preventative surgeries, but rather provide a contribution.”

Once the lifetime allowance was reached, any further procedures would not be funded, Watney said.

“This would place too much of a burden of cost on the collective membership of our society – raising premiums significantly.”

For Jobsz, the BRCA2 gene came from her father’s side where there was a strong presence of cancer in the breast, ovary and stomach.

Both her grandmothers were diagnosed with cancer, and her father also died from cancer when he was 39.

It wasn’t until her uncle was diagnosed with male breast cancer her suspicions were confirmed about having the gene.

Having her ovaries removed would cause infertility, but Jobsz said she needed to focus on the positive side of things.

She started a blog following her diagnosis to discuss her feelings and bring awareness to the issue.

“It is really scary to deal with knowing my risk of ovarian cancer is so high, and I’m not the only one dealing with this.”

Jobsz has found it hard to juggle motherhood with recovering from surgery.
ANNA JOBSZ
Jobsz has found it hard to juggle motherhood with recovering from surgery.

AUT lecturer Susan Mahon understood the struggle Jobsz faced. She found she carried the BRCA gene two years ago.

“I had my ovaries out a week after being tested, before I even had a mastectomy, and they found a large high-grade serous carcinoma in my right ovary.”

Mahon said she had been “lucky” her ovaries were removed so early, before she reached the $40,000 cap.

“If I had gone public and waited six months to go through the system I would be dead.”

Jobsz said she was considering taking her case to the Insurance and Financial Services Ombudsman.

 

READ MORE:
Remembering Helena McAlpine
Anna Jobsz undergoes mastectomy
Recovery from a mastectomy