‘My insurer won’t pay for my preventative treatment’

Insurance Private Medical Insurance Medical Conditions

Talia complains her private medical insurer won’t cover her for preventative treatment.

What happened

Talia’s mum and sister had both been treated for breast cancer. Talia had some medical tests which identified she carried a gene which placed her at higher risk of getting breast cancer.

Talia wanted to claim under her private medical insurance for treatment which she felt would lower this risk. But the insurer said it wouldn’t cover this type of claim, which Talia didn’t think was fair and complained to the insurer.

Unhappy with the response, Talia referred her complaint to us.

What we said

We looked at the policy terms which clearly said Talia wasn’t covered for preventative treatment. We also checked the medical evidence which confirmed Talia was currently in good health and had no sign of cancer.

We explained to Talia the treatment she wanted to have was designed to prevent her developing cancer in the future – and her policy only covered her for treatment following a cancer diagnosis.

As Talia’s policy didn’t provide cover for preventative treatment, we didn’t think it was unreasonable for the insurer to decline her request.