Government response to public cancer care limitations

NZ Herald has reported on Mandy Grantley’s cancer story. After Mandy was first diagnosed with bowel cancer she underwent chemo for six months. After finding out that the cancer had spread to her lungs, an additional six months of chemo and an unfunded drug, Cytoxan was recommended by three oncologists working within the public health sector. Mandy was informed that she could have her chemo at her local DHB hospital. She was told that she had to pay $64,000 for the drug herself and was redirected to a private clinic to have the drug administered. The drug was intended to simply prolong her life. With a young family, a struggling business, and an existing mortgage Mandy and her friends decided to set up a Givealittle page to raise funds. The experience made Mandy reassess the public health system. National deputy leader Shane Reti is seeking MPs to support his bill that will allow privately-funded cancer medicines to be administered through DHBs. In response, Finance Minister Grant Robertson has said that Labour wouldn’t support the bill as it would be adding to existing inequalities. Instead, the Government would focus on funding more cancer treatments through Pharmac.

“A woman battling cancer says heartbreak has turned to anger at the way she was forced to pay $64,000 for treatment advised by public health oncologists.

Mandy Grantley was given two years to live after bowel cancer spread to her lungs last year.

"They found a tumour in my bowels and removed it, which was all good," she told RNZ. "I had six months worth of chemo. After that I had a scan and it all looked good. It wasn't until last year during lockdown I was told over the phone it had spread to my lungs."

Grantley said she was then told by three different oncologists working within the public health system that her best course of action would be another six months of chemo alongside being administered unfunded drug, Cytoxan.

She was told she would need to go to a private clinic to have the drug administered after paying for the drug herself, and then go to get chemo at her local DHB hospital. The news was traumatic and overwhelming.

"The chemo was bad enough, but then being told you had to pay $64,000 for a private drug, which won't cure me but will prolong my life, and a better quality of life, I just thought, I can't do this.

"I have three young kids and a husband with a struggling business, we don't have $64,000. We would be remortgaging the house, which we already had a huge mortgage on."

Concerned for her family, Grantley persevered and two friends set up a Givealittle page and managed to raise the money.

The private drug cost her $27,000. To get it administered she had to pay a private clinic $36,000.

Grantley says she knows how lucky she is, but remains angry others will not be able to access money or credit to save their own lives.

"It makes me sick to my stomach that others out there don't have that opportunity ...  those poor families behind me - it's just wrong," she said.

Having to go to two different medical facilities was also stressful and time-consuming, with Grantley relying on people to drive her to and from the clinic and public hospital, she added.

To add insult to injury Grantley had to pay $8000 GST on her treatment. The experience has made her reassess the merits of the public healthcare system and the Government's priorities.

"They're making money out of me dying. So much for a free health system. When you really need it, you're on your own and you don't know what it's like until someone close to you goes through it. I was really upset, I was heartbroken. But now I'm just damn well angry."

Grantley finished her treatment in November and her scans since have come back clear, the latest a scan in February. She has another scan this month and remains hopeful.

"I've never felt so good, never felt so healthy."

She said her health outcome so far had proved the efficacy of Cytoxan as an anti-cancer drug.

National deputy leader Shane Reti is asking MPs to support his bill seeking to allow privately-funded cancer medicines to be administered through DHBs, to reduce the financial burden on those with cancer.

However, Finance Minister Grant Robertson told RNZ the Government would not be supporting the bill when it comes before Parliament because it would only add to existing health inequalities.

"It is a challenging area where people are self-funding the drugs because obviously for the most part what we want to do is fund people's treatment through the public system and then all of the costs and so on associated with it are managed that way," he said.

"The reason that we're not looking to move in this area is because what effectively it would mean is that somebody who does have enough resources to fund their own treatment would end up taking up space in the public health system that would otherwise go to people whose cancer treatment is publicly funded.

"So actually it would have the effect of exacerbating inequality rather than creating fairness."

He said the Government was instead focused on funding more cancer treatments through its Crown entity Pharmac. Click here to read more


New Partners Life partnership means update to claims system

An announcement on Partners Life and FINEOS Corporation claims system partnership has been made public. The partnership will mean that current claims systems and processes will be replaced. See details below.

“DUBLIN--(BUSINESS WIRE)--FINEOS Corporation (ASX:FCL), the market-leading provider of group and individual core systems for life, accident and health insurance, today announced that Partners Life, following a comprehensive market evaluation of Claims Management System vendors, has selected the FINEOS Platform for life insurance and medical claims.

The Partners Life and FINEOS partnership will bring about changes focused on replacing existing claims systems and processes with a differentiated value proposition. This will bring key operational benefits such as efficient, integrated and automated workflow processes and accurate claims covering life, TPD, trauma, income protection and medical products.

Speaking about the selection, Tracey Lonergan, Partners Life Chief Claims Officer said, “Claims service is at the core of Partners Life’s business and so when we looked for a credible provider it was important that the provider had the capability, experience and infrastructure to deliver and support a Claims Management System that would integrate into the Partners Life ecosystem. Also important to us was that the selected vendor come with a strong record of successful implementations and strong support of its Claims Management System within the New Zealand and Australian life and health insurance industry. FINEOS met these requirements. Our initial collaboration has been extremely positive, and we envisage that the project will deliver high quality results”

Commenting on the deal, Michael Kelly, CEO, FINEOS added, “We’re delighted that Partners Life has selected to partner with FINEOS and adopt the FINEOS Platform for life insurance and medical claims. The FINEOS Platform includes a market tested, pre-configured pack for the region known as LISA (Life Insurance Solutions Australasia). This is an exciting project for us in New Zealand and we look forward to a fast and smooth system implementation to enable the benefits of using FINEOS as early as possible thereby delivering a high-level service to its customers and independent financial advisers across New Zealand.

The FINEOS Platform provides a comprehensive SaaS end to end core solution for the Global Life, Accident and Health market. Key to the solution is the rich functionality that underlies FINEOS AdminSuite, FINEOS Engage and FINEOS Insight, a common set of capabilities including workflow, rules engine, customer management, no-code/low-code configuration tools, a standardized API connection and the cloud environment powered by AWS.”

More details for FINEOS can be found here. We think that claims automation will become increasingly important to ensure a range of claims goals: such as fair application of policy terms, meeting the requirements of good conduct obligations, containing costs, and speeding up the whole process. 

 


nib Group deploy new digital claims process, and more daily news

nib has announced the implementation of Melvin, a machine learning engine, that will process claims that are submitted via the app. The adoption of this engine is intended to reduce manual data entry. Brendan Mills, nib Group CEO, has said that after nib enabled photo submission and claims via the app, user experience improved while information processing time increased. 

“Nib has implemented a new machine learning engine to process claims submitted via its app in less time by reducing the amount of manual data entry required behind the scenes. 

 

Five years ago the health insurer introduced a new feature that let members take a photo of their receipt and submit a claim via the app. 

While that improved the customer experience, it became a challenge to process the information at the backend as the volumes of photos increased, said nib's CIO Brendan Mills.

 

“We created a great customer experience but we then also caused ourselves some pain in processing photos because we're then taking a whole heap of flat images and having to rekey all the data [such as] provider number, customer number…it was quite an intensive process,” Mills told iTnews.

nib has said been trialing systems for the past six months. The engine uses AWS Textract to pick up all relevant information from submitted photos. The engine is set to save 20 seconds in handling time per claim, with half not needing further human intervention. nib is looking at expanding the service to process more claims, improve the service, and improve accuracy. 

“For the past six months, the health insurer has been using machine learning algorithms to strip information from the photos and pass it through to the core claims processing system. 

 

The engine, dubbed Melvin, was developed with data science consultancy Eliiza and uses AWS Textract to read the relevant information from the photos. 

 

Mills said the process saves an average of 20 seconds handling time per claim, and about half of the claims require no further human intervention to rekey or adjust any of the fields from the image. 

 

The insurer is now considering how to expand the service to process more claims, improve accuracy levels and determine if claims can be paid out without any human intervention. 

 

Mills said work is underway to determine the types of claims that have a very “high confidence” level to approve automatically, possibly with a post-processing quality assurance mechanism in place.” Click here to read more

In other news:

nib: adult or child signing up to Easy Health, Ulitimate Health Max, or Ulitimate Healththrough nibAPPLY will give them two month free cover. Offer ends 31 January 2021

FMA: FMA seeks consultation on proposed guidance for advertising

SHARE: SHARE confirms Newpark acquisition


Science behind high Income Protection premiums, and more daily news

Recently we reported that Income Protection prices are on the rise as a result of the Australian market and COVID-19. New Zealander insurers are now being urged to amend processes and premiums before regulators intervene and introduction mandatory guides. Partners Life begun the conversation when revealing that it has increased IP premiums by 12% and made policy changes. Kris Ballantyne, chief marketing officer, has said that Partners wishes to offer affordable policies that customers can maintain for as long as they need. AIA and Cigna have both noted that they aren’t looking to introduce significant premium increases.  

“It took insurer Partners Life to break the silence last month when it revealed a brave plan to start publishing the content of discussions with the Financial Markets Authority.

 

In doing so, it revealed it lifted its income protection premiums by 12 per cent in the past year, and had made policy changes, including not allowing self-employed people to any longer select an “agreed value” of income to be covered, instead limiting cover to actual loss of earnings.

 

Partner’s Life’s chief marketing officer Kris Ballantyne said the company was a “first mover” on income protection, driven by wanting to provide policies they [consumers] could afford to keep as long as they needed it.

 

It was a big challenge as there were a lot of agreed value policies covering self-employed people, and owners of small businesses.

 

Neither of its two big rivals, AIA nor Cigna, was expecting to make such large premium increases, though AIA had stopped selling new policies in which the income covered automatically increased by 5 per cent a year.

 

AIA chief product officer Len Elikhis said that over time, “the insured’s benefits would creep up and approach the insured’s income”.

Shane Burdack, senior underwriting consultant as Swiss Re Australia highlighted that customers with significant wealth had very little incentive to return to work when on claim, resulting in increased premium prices.

“Swiss Re senior underwriting consultant in Australia, Shane Burdack, said that in New Zealand insurers gave little thought to the net wealth of policyholders.

 

Yet people with significant wealth – sometimes through investments, sometimes because of payouts from other insurance policies – had a low incentive to go back to work, and stayed “on claim” for longer driving up costs.” Click here to read more

  

In other news

nib: nib takes place among top 100 most diverse firms worldwide

Southern Cross: Southern Cross is offering members a $149 voucher when they join Snap Fitness on a minimum 12-month term

Southern Cross: Southern Cross is offering members 10% off the retail price of a monthly LES MILLS On Demand subscription

 

 

 


Pinnacle Life unpack life insurance discussions, and more daily news

Pinnacle Life has published tips on how to discuss life insurance with a significant other. Pinnacle Life begins by encouraging those that have never discussed money or life insurance with their partners to do so as it is an important part of planning for the future.

“Talking about life insurance means talking about death. No-one finds that easy. Pinnacle Life has some tips to get you started with talking about money and life insurance with your partner.

Not many of us have been taught how to have conversations about financial decisions. In fact, financial literacy hasn’t been on the school curriculum for very long at all – at best, it’s still optional for most schools today. There seems to be an underlying assumption that financial literacy is something you can learn yourself or pick up from your parents. But evidence suggests it’s not that easy; New Zealanders are notoriously underinsured and ‘under-saved’.

In a time when the news is filled with death rates, recessions and industry failures and many of us are facing reduced incomes, it’s a reminder that it’s never too soon or too late to start having conversations about our finances and insurance. We know that it's not easy to talk about money openly and honestly; talking about life insurance can be even harder because it means talking about what will happen if you die.”

Tips include:

  1. Conducting independent research
  2. Choosing the right time to have the discussion
  3. Taking your time to plan and execute
  4. Start by looking at the big picture before honing down to the details
  5. Embrace the emotions that arise
  6. Discuss your money objectively
  7. Seek advice from a professional

Click here to see all the details

In other news

nib: new customers that sign up for Ultimate Health Max, Ultimate Health and Easy Health policies using nibAPPLY will have 2 months free until 31 January 2021

Southern Cross: 72% of all claims were paid out in 2020

82% of customer channels are now fully digitised and over 96% of claims now submitted digitally

The power of social media- Russell Hutchinson writes on goodreturns


AIA introduces claims management service, and more daily news

AIA has announced the launch of AIA 360, a free claims management service that is on offer to eligible IP customers. AIA currently spends over $1.1 million annually to assist customers on disability claims and has 26 case managers assigned to 1,300 cases.  This averages to 45 cases for each case manager. Chief Customer Officer Sharon Botica has said AIA is able to improve processes and offer better support with AIA 360.

“The insurer is launching AIA 360, which is described as "a personalised end-to-end claims experience providing support, guidance and rehabilitation."

The programme will be available to eligible income protection claimants and is offered free of charge.

Currently the company spends more than $1.1 million a year helping people on disability claims. It has 26 case managers looking after 1,300 rehabilitation cases.  This is about 45 cases for each case manager.

"We keep these numbers low so we’re able to provide a good level of individualised and tailored care and support to each customer," AIA chief customer officer Sharon Botica says.

She says the programme will provide support and guidance throughout the claims journey.”

Advisers will be able to offer customers support during the digital claim process. Although the service is currently being offered to those making IP claims, AIA is looking to expand the service offering in the future.

“Botica says will the company is trying to digitalise many of its processes, DI claims management requires the personal human-to-human touch.

"People are in a very vulnerable position when they claim," she says.

Botica says advisers will be able to give clients comfort that if they have to make a DI claim, there is a full service to support them.

360 Care will give clients confidence at claim time, she says.

360 Care is an evolving claims experience that will be available to more claimants in the future.” Click here to read more

In other news

Cigna: David Haak appointed as new General Manager – Distribution

Professional IQ: Advisers find “unexpected benefits” from completing Level 5

Strategi: AML compliance update webinar

FMA: World Investor Week live Q&A webinar

FSC: Financial Services Council  Annual General Meeting 2020

Partners Life: transparency, trust & the right thing to do webinar


Partners to publish company insights, and more daily news

Rob Stock, writing for Stuff.co.nz tells that Partners Life has announced that it will be releasing a publication that reveals insight into many aspects of the business in the coming weeks. Chairman Jim Minto has said that information about complaints, unsuccessful claims, IP premium increases, and withdrawn products will be included in the publication.

“Life insurer Partners Life will begin publishing information about the $2.7 billion-a-year industry which is usually kept from the eyes of the public, and is challenging other insurers to do the same.

In about four weeks, Partners Life’s chairman Jim Minto said the company would begin publishing information including the number and types of complaints the company received from customers, and the proportion of claims not paid.

It will reveal 9 per cent of its claims made were not paid.

Other uncomfortable information it would reveal include the 12 per cent increase in premiums on its trauma and income protection policies, which had seen spikes in claims, and the 314 complaints it had from among its 201,000 policyholders.

It has withdrawn its funeral cover, a type of insurance the FMA and Reserve Bank criticised as poor value, and will reveal details of changes in its underwriting on policies to limit the risk presented by the Covid-19 pandemic when accepting new policyholders.”

Naomi Ballantyne said that the evidence Partners submitted to the FMA and RBNZ should also be shared with customers. Naomi suggested that the publication of such information would encourage competition to offer fair treatment and create a record of insurer promises, minimising backtracking.

“Naomi Ballantyne, Partners Life managing director, said in 2019 the FMA and Reserve Bank told insurers to provide evidence that they were not ripping off customers.

Insurers had to comply, leading to the September 2019 report in which no insurers were named and shamed.

Ballantyne said: “Having done that huge piece of work, and having the regulator know all of the things we do, we said, ‘Well, that’s great to tell the regulator, but no-one else knows’.”

“All that information we provide to them, we felt we should provide to our customers,” she said.

If all life insurers published the information it would encourage competition around good behaviour towards policyholders, but also create a public record of promises from insurers to policyholders, making it hard for companies to backtrack on them.” Click here to read more

This is a valuable initiative. Of course, much of this information is hardly confidential - but the level of detail in the disclosure is new. I know that the industry, working through the Financial Services Council, is keen to develop more data sharing. Meanwhile, pro-active disclosures of this type are valuable, adding to the transparency in the market and allowing journalists and consumers to understand what happens at insurers. 

Common claims payment reporting is a difficult area - defining what counts as a potential claim is critical to establishing an accurate and comparable number. For example: given Partners Life's high levels of income protection and trauma coverage a claim decline rate of 9% does not sound particularly bad, given the usual disagreements, misunderstandings, and that fraud is real. An insurer that issues only life insurance could probably report a much lower number - because death is harder to fake than, say, attempting to stretch out an IP claim because the jobs market is tough right now. An encouraging thought is that having a good conversation about what claims get paid, and what should not, gives confidence to consumers in what they are buying and its sustainability. 

In other news:

Suncorp: Customers only cutting insurance as an “absolute last resort”


Southern Cross experience a surplus, and more daily news

Southern Cross has reported a surplus of $32.4 million for the year ended 30 June 2020. This financial reporting comes after the $50 million return to members. $972 million was returned in claims in the last financial year, this equals to 85 cents in claims being returned for every dollar received in premiums.

“Southern Cross Health Society Group has today released its annual financial results, posting a surplus of $32.4 million for the year ended 30 June 2020.

The announcement follows Southern Cross Health Society’s pledge during the Level Four lockdown in April to return $50 million to its members.

In the last financial year, the Society returned $972 million in claims and received $1.138 billion in premiums.

For each dollar received in premiums, it returned 85 cents in claims to members, compared with an average of 62 cents in the dollar among other New Zealand health insurers.”

“The business paid out 72 per cent of all private health insurance claims, significantly more than its 62 per cent market share based on Health Funds Association of New Zealand data.

Nick Astwick said that Southern Cross was focused on members during the last financial year. This included pledging to return $50 million, setting up employees to effectively working from home and ensuring the business digitisation process is on track.

Chief Executive Nick Astwick said the Society’s focus during the last financial year was on taking care of its members: “We were with our members from the start of the pandemic, returning $50 million to them, and introducing a significant range of options for those in need of hardship relief.

“At the same time, our workforce was very quickly set up to work remotely, ensuring service levels were seamlessly maintained.”

Astwick said cost-saving digitisation of the business had continued at pace, with 82 per cent of customer channels now fully digitised, and more than 96 per cent of claims submitted digitally.” Click here to read more

In other news

Southern Cross: Woman who lives in fear of jaw dislocation determined to get replacement

Southern Cross: Southern Cross gives support to students' mental health programme

AIA: Depressed man wins $173,000 battle with insurer AIA - there will be more discussion of media claims coverage in the forthcoming quarterly life and health sector report. 


Insurer wins argument over chronic pain claim, and more daily news

The Court of Appeal revealed its verdict on the case between Asteron Life and financial adviser Peter Taylor. According to the story: Peter Taylor made an Income Protection claim in 2010 saying that as a result of his bone cancer he was suffering from chronic pain. Peter was able to get payments after supplying the required information on his medical condition and ability to work, but in 2014 Asteron Life suspended the payments stating Peter’s earnings made him ineligible for payments.

"The Court of Appeal released its judgment on Wednesday.

Taylor first took an Asteron Life income protection policy in 1994 and made a claim in 2010, saying he had bone cancer and suffered chronic pain.

Taylor was required to provide progress reports to Asteron describing the current state of his medical condition, whether he had been able to work, what income he had earned from working, and certain other matters.

He received payments until September 2014, when Asteron suspended them. It was concerned that he was earning at a level that would make him ineligible.”

Unhappy, Peter went to court arguing that he was still entitled to payments.  Asteron Life stated that he was no longer entitled to payments and counterclaimed for repayment of the amount paid out to Peter. The court noted that Peter used the payments for holiday homes, cars and overseas trips and ruled in favour of Asteron Life. The insurer was awarded $371,286.70.

“Taylor went to court seeking a declaration that he was entitled to continuing benefits under the policy, and wanting arrears of payments.

Asteron denied he was entitled to any further payments and counterclaimed for repayment of all sums previously paid.

It said he had made false statements about the extent to which he worked while on claim.

The High Court sided with Asteron and it was awarded $371,286.70. That court noted that he had used his insurance payouts to fund a holiday home, cars and overseas trips.”

Peter then took the case to Court of Appeal. The judge again ruled in favour of Asteron Life saying that Asteron Life was entitled to a reduced counterclaim payment of $51,835.64.

”The Court of Appeal said Asteron was entitled to succeed in its counterclaim but could only recover payments made in respect of the periods about which Taylor was found to have dishonestly provided false information.

“The judge declined to find that the initial claim made in July 2010 involved false statements that breached Taylor’s obligations in relation to making claims. So Asteron’s claim as pleaded, which was founded solely on the allegation of breach of utmost good faith, could not succeed in respect of the initial period from January 2010 to July 22, 2010.

“There may well have been another basis on which the payments made in respect of that period could have been recovered. But they were not pleaded by Asteron, and Asteron did not give notice that it intended to support the High Court judgment on grounds other than those accepted by the judge.”

That reduced the amount owed to Asteron by $51,835.64. Taylor has since sold his insurance broking business. Click here to read more

In other news:

Financial Advice webinar: Economic Update by Economist Tony Alexander

Financial Advice: 2020 Conference registration

AIA: COVID-19 UPDATE