The backflip by health insurer HBF, which had told 26-year-old Kate Poland she had to wait 12 months to qualify for surgery that included a knee replacement, came within hours of _The Weekend West _querying its decision yesterday.
The Princess Margaret Hospital doctor, who has been with HBF for 10 years, was booked to have surgery at Hollywood Private Hospital three days ago but had to cancel when HBF confirmed she was not covered because her policy excluded knee replacements.
Dr Poland was diagnosed with bone cancer in her lower right leg two years ago and had surgery, funded by HBF, to remove the tumour and pack it with a type of medical cement.
When the cancer returned last month, her surgeon said the best chance was to remove part of the tibia, or shin bone, and reconstruct the knee using an artificial joint.
But because it involved a joint prosthesis, HBF said it could only cover such surgery after Dr Poland met the 12-month qualifying period for her upgraded policy, during which she says the cancer might have spread and forced doctors to amputate her leg.
Dr Poland said she was relieved by HBF’s change of heart but was critical the insurer’s dispute resolution process had not looked at the “bigger picture”.
Her only other option had been to wait up to four weeks for publicly funded surgery at Sir Charles Gairdner Hospital.
“I’ve had private insurance since birth and am a strong believer in having appropriate cover but clearly I did not expect to need this operation at my age,” she said.
“It’s been nonsensical that my insurer would fund other surgery, even an amputation, instead of the surgery that’s going to give me the best chance of a cure and the ability to walk without aids and work as a medical practitioner.”
HBF public affairs manager Andrew Walton said the surgery would be funded after the case was reviewed “at the highest level”.
“We’ve taken a decision to make a discretionary payment to cover the costs of Kate’s knee replacement on the basis that unusually the knee replacement is the course of treatment she has been advised for treatment of the cancer,” he said.
“It’s a special case and very unusual for HBF to make this sort of exception.”