Parents are left devastated and broke after NIB rejects bill for their newborn son’s brain tumour 

A mother-of-five whose baby boy was diagnosed with a brain tumour was declined surgery by their private health care insurer – and warned others ‘you’re never fully covered’. 

Josh Catterick, now six years old, was just four months when his mother, Kylie, rushed him to Canberra Hospital for treatment in June 2013. 

But their private health insurer, NIB, declined to cover the cost of her baby boy’s neurosurgery – a procedure which treats disorders in the nervous system.

NIB denied the claim on the basis neurosurgery was not specified under the family’s coverage.

‘It wasn’t even that they denied it [the claim]. It was the way they treated me. It was an extremely emotional time,’ Ms Catterick told Daily Mail Australia. 

But their private health insurer, NIB, declined to cover the cost of her baby boy’s neurosurgery – a procedure which treats disorders in the nervous system (pictured Kylie and Josh)

Ms Catterick recalled how she felt helpless and in ‘shock’ after being told her son could not be given the surgery he desperately needed. 

‘I tried to fight our case at the time but I didn’t have much in me to fight,’ she said. 

‘I feel like they took advantage of my emotional state. They walked all over me.’ 

Ms Catterick later learned that NIB would only decline to cover health costs if the specific treatment is mentioned under the insurer’s exclusion policy. 

If the treatment is not mentioned as an exclusion, it can be covered under the family’s health fund. 

Neurosurgery was not a procedure mentioned under NIB’s excluded treatments, meaning Josh had the rights to be covered.

Josh’s successful operation was fortunately covered by the public health care system. 

Ms Catterick said she tried to plead her case when she contacted NIB. 

But she claimed a representative bluntly told her: ‘We’re not going to change our minds. We’re not going to.’ 

‘I was speaking to the employee on the phone, on Bluetooth, while I was driving,’ she said. 

‘And he even had a go at me for talking to him behind the wheel, even if it was a wireless conversation.’ 

NIB denied the claim on the basis neurosurgery was not specified under the family’s coverage

Following the experience, Ms Catterick cut off her private health care with NIB and switch to a new health fund, HFC. 

She has urged for everyone to read the fine print before signing up for private health care. 

‘People need to read the fine print. Don’t just read it but understand it,’ she said.  

‘If you think they’re wrong, you need to fight.

‘If you’re in an emergency situation like that, most people don’t have the strength to challenge the system.’ 

Since the incident, Ms Catterick has become an advocate for Medicare. 

‘I’ve gone through surgery myself through the public system and I can’t fault my treatment,’ she said. 

‘It’s not perfect. It needs work but Medicare is getting there.’    

‘It wasn’t even that they denied it [the claim]. It was the way they treated me. It was an extremely emotional time,’ Ms Catterick told Daily Mail Australia

Josh was transferred to Sydney Children’s Hospital for a follow up surgery, after his operation at Canberra Hospital.      

The family are among thousands of Australians who are ditching private health insurance.

The number of people with health insurance fell to 44.6 per cent for the year ending 2018, according to data released by the Australian Prudential Regulation Authority.

It is the lowest figure since 2006.

The steepest decline was among 20 to 29-year-olds, with 33,975 abandoning their cover.

The family are among thousands of Australians who are ditching private health insurance

According to the Grattan Institute, Australia’s private health insurance industry is in a ‘death spiral’.

Researchers claim the ‘spiral’ is being caused by the young and the healthy dropping their cover, leaving those who were more likely to get sick and go to hospital, which has been driving insurance costs up further.

They blamed the problem on premiums rising faster than wages or inflation.

Australian Medical Association president Tony Bartone told the National Press Club in Canberra on Wednesday Australians were dropping out because they knew when they were being sold a dud.

‘Private health insurance is currently in trouble – real trouble,’ he said.

Following the traumatic experience, Ms Catterick cut off her private health care with NIB and switch to a new health fund, HFC (pictured: Josh Catterick)

Mr Bartone argued private health insurance reforms must address variation in rebates and the indexation of rebates to help curb the 15 successive quarters of decreasing coverage.

‘This reform needs to start now. We can’t wait for another dozen quarters of decline. The death spiral is already under way,’ he said. 

He said immediate actions must also be taken to improve aged care, including the introduction of a minimum staff-to-resident ratio that matches the level of care needed in each facility.

The AMA also wants Medicare rebates boosted by at least 50 per cent for doctors who visit aged care centres.

Ms Catterick recalled how she felt helpless and in ‘shock’ after being told her son could not be given the surgery he desperately needed

More than half of Australians are living with a chronic illness such as arthritis, cancer, respiratory disease, heart disease or diabetes, according to the Australian Institute of Health and Welfare.  

Dr Bartone’s comments come after the government committed in May to creating a new long-term preventative health plan. 

He stressed the importance of investing in preventive health policies and the need for a tax on sugary drinks, restrictions on junk good advertisements to children and a new national alcohol strategy.

‘We can’t expect the health system to continually get us out of a pickle because we have played gay indifference to looking after ourselves,’ he said. 

Daily Mail Australia has contacted NIB for comment.