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Barrister takes health insurer to court over refusal to pay for ADHD diagnosis
A Waikato barrister is taking Southern Cross Health Insurance (SCHI) to the disputes tribunal after it refused pay out $1000 for his ADHD assessment.
The lawyer, who doesn’t want to be identified as someone with ADHD, had health insurance which included cover for psychiatrist consultations.
He booked a consultation with Psychiatry NZ, which provides consultations by telehealth.
The assessment was done by a doctor at the practice who was in training to become a psychiatrist. RNZ has agreed not to name him.
But, he was supervised by Dr Han Chung Lim, a registered psychiatrist, who then signed off on the assessment.
Despite this, Southern Cross declined the claim because the assessment was not done by a registered psychiatrist. Instead it categorised the consult as a GP visit, and paid $65 for the hour-and-a-half long, $1000 appointment.
“If I had gone to my GP, and they had done this, the cost would be much lower, and would be appropriate for SCHI to apportion it this way,” the barrister said. “My GP did not offer this service.”
GPs have recently gained the ability to conduct ADHD assessments – but the doctor who performed the assessed was not technically a GP, either.
The Medical Council’s register lists them as having a “general scope of practice” which is not the same as being a GP.
“General practice is a specialty area of practice,” it said. “Doctors registered in the general scope of practice can work in any area of medicine. They are required to participate in an approved recertification programme to assist them in maintaining their competence.”
The barrister told RNZ it wasn’t about the money – rather, he thought Southern Cross had denied the claim in bad faith.
“Working as a criminal barrister, I see the significant impact the lack of access to affordable, and timely psychiatry care has on my clients, particularly those remanded in custody and sentenced prisoners,” he said.
“The benefit for me, as someone very privileged, to have access to psychiatry care has been life changing. SCHI’s approach limits, rather than improves access across the board.”
If his case was successful, he intended to donate the money to ADHD NZ.
Supplied / Southern Cross
Southern Cross Health Insurance chief sales and marketing officer, Regan Savage, told RNZ in a statement the policy only provided cover for psychiatrist consultations with vocationally registered psychiatrists.
“The member was informed of the policy terms and extent of cover before undertaking the assessment but chose to proceed with receiving the service from a GP.
“In this case, the provider was not registered as a psychiatrist, so the claim did not meet the benefit criteria.”
Savage said it was important that Southern Cross applied policy terms consistently for all members to promote fairness. “The policy terms are clear that, for specialist benefits such as psychiatrist consultations, providers must hold the relevant vocational registration.”
The company regularly reviewed products and policy settings to make sure they remained appropriate for members and sustainable over time, but “we are not currently considering changes to enable cover for GP consultations under the psychiatrist consultations benefit”.
Dr Lim from Psychiatry NZ said his doctors had been providing telehealth assessments for ADHD under his supervision for the past two to three years.
He said they always advised people to get pre-approval, or check with their insurer that the appointment would be covered, at the time of booking, as they knew some insurers would refuse cover.
rnz
All Blacks coach Dave Rennie has made several changes from the team that beat the Springboks at Ellis Park for Sunday morning’s second test in Cape Town.
Prop George Bower, who helped steady the All Blacks scrum after coming off the bench in last weekend’s 33-16 win in Johannesburg, replaces Ethan de Groot, who is out with concussion, in the starting front row.
Codie Taylor and Tyrel Lomax are retained at hooker and prop respectively.
Tupou Vaa’i moves from blindside to lock, replacing Josh Lord, who was also ruled out of the second test following a head clash with de Groot last week at Ellis Park.
Vaa’i will partner with Fabian Holland in the second row.
Samuel Shivambu/BackpagePix
Chiefs loose forward Simon Parker gets the nod at blindside flanker, filling the spot left vacant by Vaa’i’s move to lock. Parker beats out the likes of Wallace Sititi and Ethan Blackadder, who was man of the match in Wednesday’s win over the Lions.
Ardie Savea captains the side from No.8 with Luke Jacobson at openside.
Hurricanes front rower Xavier Numia comes onto the bench to provide prop cover, while veteran Patrick Tuipulotu has been named in the reserves to cover lock.
In the backs, there is one change from last week’s team, with Leroy Carter taking over on the left wing from Josh Moorby, who drops to the bench.
The backline remains the same bar the change on the wing, with Cam Roigard at halfback, Ruben Love at first-five, Jordie Barrett and Quinn Tupaea in the midfield.
Damian McKenzie, who will be playing his 34th consecutive test, is at fullback with Will Jordan, the All Blacks all-time leading try scorer, on the right wing.
Andrew Cornaga/www.photosport.nz
Jordan extended his record to 53 tries last weekend, joining English winger Rory Underwood in sixth place on the men’s international test try-scoring list.
Japanese winger Daisuke Ohata holds the record with 69 tries.
Rennie said there’s fierce competition for spots in the matchday 23 and he expects both teams to improve on their performances last weekend in Johannesburg.
“While we were happy with the win last week, I think both teams will be better this weekend,” Rennie said.
“We’ve played four tests this year and are still growing as a group. I’m really excited about the competition for places and the performances of the squad across the matches here in South Africa, and we’re really looking forward to this weekend.”
Asafo Aumua is the reserve hooker, Fletcher Newell and Numia the back up props, with Peter Lakai the one loose forward on the bench, which also includes midfielder Anton Lienert-Brown and halfback Kyle Preston, who has played all five of the All Blacks games in South Africa so far.
Ron Gaunt/www.photosport.nz
The All Blacks lead the four test series 1-0 and know a win in Cape Town this weekend would heap even more pressure on the hosts and go a long way to securing a series victory.
The All Blacks have played South Africa 111 times, for 64 wins, 43 losses and four draws.
The All Blacks will be playing only their second ever test match at DHL Stadium, with all ten previous Cape Town tests played at the old Newlands Stadium.
New Zealand won seven of those 11 previous tests against the the Springboks in Cape Town, with the last win nine years ago in 2017.
The Springboks won the most recent test, beating the All Blacks 31-27 in 2024.
This weekend’s second test kicks off at 5:10am Sunday (NZT).
All Blacks match-day 23 (Test caps in brackets)
1. George Bower (27)
2. Codie Taylor (110)
3. Tyrel Lomax (52)
4. Fabian Holland (13)
5. Tupou Vaa’i (48)
6. Simon Parker (9)
7. Luke Jacobson (28)
8. Ardie Savea (110) – Captain
9. Cam Roigard (21)
10. Ruben Love (9)
11. Leroy Carter (8)
12. Jordie Barrett (82)
13. Quinn Tupaea (27)
14. Will Jordan (58)
15. Damian McKenzie (78)
16. Asafo Aumua (23)
17. Xavier Numia (2)
18. Fletcher Newell (38)
19. Patrick Tuipulotu (57)
20. Peter Lakai (11)
21. Kyle Preston (2)
22. Anton Lienert-Brown (91)
23. Josh Moorby (3)
rnz
Police have been hunting through the night for those responsible for a suspected double homicide in Wattle Downs, South Auckland, on Thursday.
Emergency services responded to reports of a woman unresponsive at an address on Gambare Place about 1.45pm.
The woman was pronounced dead at the scene and, during a search of the property, police found a man who was also pronounced dead.
Detective Inspector Tofilau Faamanuia Va’aelua said the offender or offenders fled the scene prior to officers arriving.
On Thursday evening, armed police stood guard in front of the house, as neighbours looked on.
Dianna Kereopa-Turner had lived in the street her whole life. She told RNZ she had just returned home when “havoc started going on” outside.
“We thought it was our nail gun for our sleepout that we’re building going off … and then it was quite loud,” Kereopa-Turner said.
“But no, it was shooting. All we heard was gun. Then my sister came out of her room and said ‘somebody out there’s shooting’, so we gathered in whoever was loose around the house and stayed inside.”
She said the victims had only just moved in to the street: “It’s sad to know that whatever trouble was following them, obviously followed them right to the doorstep, and unfortunately it happened on this street where there’s a lot of kids and a lot of elderly people.”
RNZ / Erin Johnson
Many residents had been unable to return to their homes on Gambare Place and adjoining Volante Avenue while police cordons closed the roads on Thursday afternoon, with armed police stationed at the cordons.
Another Gambare Place resident, Bobbie, said she had been at the doctors and tried to return home around 2.45pm.
“The street was already closed off, so I thought, ‘oh better shoot over to the school and pick up my niece’, got over there and it was locked down as well.”
Bobbie said they were allowed to go home just after 5pm.
She said, once home, she talked with neighbours and some were quite shocked.
While the cordon was in place, police were seen working behind a white tarpaulin on Volante Avenue. Police later confirmed staff had moved the victims to a safe location, away from the scene, to render first aid, while other staff continued working to clear the scene and make it safe.
Va’aelua said the incident appeared to be isolated, but police were not able to “rule anything out”, and were now determining the exact cricumstances of the incident.
“This is an awful set of events and no doubt unsettling for everyone involved and the wider community.”
Anyone with information on the incident that could help police with enquiries could contact 105.
rnz
Rescue teams are searching for a New Zealand teenager missing after a boat carrying him and three other people capsized in Bangladesh, officials say.
Albert, 16, whose surname was withheld by police, went missing after the boat overturned in rough waters on Tuesday morning (all times local) near an estuary off Cox’s Bazar on the country’s southeastern coast.
Do you know more? Email iwitness@rnz.co.nz
The other three New Zealanders on the boat were rescued by fishermen nearby.
“The Coast Guard is searching for the boy while a helicopter is conducting an aerial search. Fishermen have also been alerted about the missing teenager,” an official told AFP on condition of anonymity as he was not authorised to speak to the media.
Rescue efforts have been hampered by rough conditions in the Bay of Bengal, he added.
999 NATIONAL EMERGENCY SERVICE BANGLADESH / SUPPLIED
Mohammad Ali, the officer-in-charge of Cox’s Bazar police station, said the four had been on a trip when the boat met with an accident.
Local media reports said the four were from the same family but officials were unable to confirm that information immediately.
– AFP
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