Southern Cross Health Insurance has been ordered to pay a customer $355 after the Disputes Tribunal found it had wrongly declined to cover a portion of his ADHD diagnosis.<\/p>\n
The man’s policy included cover up to $600 per year for consultations with a vocationally registered psychiatrist.<\/p>\n
In order to get treatment for ADHD, he had a consultation with a doctor, who was in training to become a psychiatrist but was not yet vocationally registered, and then the report and prescriptions were signed off by their supervising doctor, Dr Han Chung Lim, who was registered.<\/p>\n
Southern Cross argued as the doctor who did the assessment and the report was not a registered psychiatrist, the customer was only covered for a GP visit, to the amount of $45.<\/p>\n
The tribunal accepted that point, but ruled the portion of the work done by the registered psychiatrist should also qualify for cover.<\/p>\n
The man sought $1000.01, but ultimately the tribunal determined $400 was a reasonable amount for the qualifying portion of the consultation, and deducted the $45 Southern Cross had already paid, for a total of $355 to be paid.<\/p>\n
In a statement, Southern Cross said: “We are currently reviewing the decision and considering our next steps, including those outlined by the Disputes Tribunal in its decision.”<\/p>\n
The barrister told RNZ he was pleased with the decision.<\/p>\n
“It vindicates my view that Southern Cross are out of step with the needs of its customers.<\/p>\n
“Being treated remotely, particularly post-Covid, should be embraced. In this case, seeing [the doctor], remotely, who is supervised by Dr Lim, a psychiatrist, allowed improved access, without reducing the quality of care.”<\/p>\n
He hoped the decision would prompt Southern Cross to work on improving, rather than restricting, access to psychiatry care.<\/p>\n","protected":false},"excerpt":{"rendered":"Southern Cross Health Insurance has been ordered to pay a customer $355 after the Disputes Tribunal found it…\n","protected":false},"author":2,"featured_media":643392,"comment_status":"","ping_status":"","sticky":false,"template":"","format":"standard","meta":{"footnotes":""},"categories":[10],"tags":[134,111,139,69],"class_list":["post-643391","post","type-post","status-publish","format-standard","has-post-thumbnail","category-health","tag-health","tag-new-zealand","tag-newzealand","tag-nz"],"_links":{"self":[{"href":"https:\/\/www.newsbeep.com\/nz\/wp-json\/wp\/v2\/posts\/643391","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/www.newsbeep.com\/nz\/wp-json\/wp\/v2\/posts"}],"about":[{"href":"https:\/\/www.newsbeep.com\/nz\/wp-json\/wp\/v2\/types\/post"}],"author":[{"embeddable":true,"href":"https:\/\/www.newsbeep.com\/nz\/wp-json\/wp\/v2\/users\/2"}],"replies":[{"embeddable":true,"href":"https:\/\/www.newsbeep.com\/nz\/wp-json\/wp\/v2\/comments?post=643391"}],"version-history":[{"count":0,"href":"https:\/\/www.newsbeep.com\/nz\/wp-json\/wp\/v2\/posts\/643391\/revisions"}],"wp:featuredmedia":[{"embeddable":true,"href":"https:\/\/www.newsbeep.com\/nz\/wp-json\/wp\/v2\/media\/643392"}],"wp:attachment":[{"href":"https:\/\/www.newsbeep.com\/nz\/wp-json\/wp\/v2\/media?parent=643391"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/www.newsbeep.com\/nz\/wp-json\/wp\/v2\/categories?post=643391"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/www.newsbeep.com\/nz\/wp-json\/wp\/v2\/tags?post=643391"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}