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Opinion: A question of coverage

One broker who was recently incarcerated in a hospital awaiting a by-pass operation got acquainted with a fellow inmate.

Wednesday, November 12th 2008, 4:50PM

by Russell Hutchinson

This chap told him that the food was worse than some prisons. That got a third cell-mate in on the game who proclaimed that he was going to get his operation privately as soon as he could to get out of there – him being privately insured and all.

A debate ensued between cell-mates – could he do that? Our broker was trying not to work, but the question just could not be put entirely to one side.

There was his own situation to think of. A memory said you couldn’t do that, and he recalled that at least one major medical contract will not cover a transfer out of the public system for surgery privately unless the patient’s condition is certified as stable.

Southern Cross say that once at a DHB the patient would have to be discharged first before seeking a claim for, say, non-urgent heart surgery. There is no provision for a direct transfer. Maybe they just don’t want the risk you’ll die on the way.

Sovereign on the other hand say there is nothing to stop you contacting a specialist – presumably from your hospital bed. But an underwriter I spoke with says: “I’d stay in the public hospital anyway if I were them… this kind of operation, done for acute admissions, you just won’t get better care anyway”.

So why have the cover for one of the largest contributors to claims? Because you don’t want to rely on having a heart attack just bad enough to get you the operation quickly in a public hospital, but not so bad it kills you.

How many cream buns a day is that?

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