Cancer-free but woman left $25,000 out of pocket
Pooja Poonia is recovering from a double mastectomy, but she and husband Harsh Dhull have paid a heavy financial price as a result of the limits of their health insurance from Southern Cross.
Poonia was diagnosed in March with an aggressive form of breast cancer and began chemotherapy during the national lockdown.
It was a terrifying time for the couple, who have a 2-year-old son, and, on the advice of their doctors, they elected for private treatment covered by their health insurance, so Poonia could be treated without delay. But just over two weeks before Poonia was to undergo a double mastectomy and breast reconstruction, the couple learnt they had to find more than $25,000 to ensure the operation went ahead because of limits on their Southern Cross policy.
The policy did not cover ‘‘prophylactic’’ treatments for people at high risk of developing life-threatening illnesses until they had had their policy for three years. Poonia had only had her policy for a few months, taking it out after Dhull changed jobs and the couple were offered health cover
by his employer.
‘‘I was in shock. We got mail from Southern Cross that it would only do the left breast, even if it was genetic, because our policy is not three years old, so it was not going to fund the right one,’’
Poonia said. The couple said the three-year time limit was arbitrary, unfair and left Southern Cross members diagnosed with breast cancer at risk.
They called on the insurer to change it for the sake of future policyholders.
Southern Cross, which is owned by its policyholders, said the limit was designed to keep premiums down.
Southern Cross covered about $80,000 of the $105,000 medical costs for Poonia’s treatment, which included chemotherapy and surgery.
But Dhull said the policy did not align with the kind of disease Poonia had.
Poonia had cancer in her left breast, but her doctors advised her to have the double mastectomy because she tested positive for the BRCA 1 gene, which gave her a more than 70 per cent chance of getting cancer in her other breast.
Southern Cross said it would only fund amastectomy and reconstruction of her left breast, as removing her other breast was considered a prophylactic procedure, despite the high risk of cancer returning.