Dermatologists say changes to health insurance cover are pushing some skin cancer patients towards cheaper and less effective treatment, RNZ reported this week.
The concern is Mohs surgery, which removes a skin cancer layer by layer while keeping as much healthy tissue as possible. RNZ says it has a 99 percent cure rate. Southern Cross, New Zealand's biggest health insurer, has narrowed when it will pay for it.
What is Mohs surgery?
Dr AJ Seine, president-elect of the New Zealand Dermatological Society, told RNZ Mohs is "the gold standard internationally recognised treatment for certain skin cancers, particularly for heads and necks".
He said Mohs looks at 100 percent of the surgical margin. The cheaper option is to cut the lesion out and hope it has all gone, which leaves surgeon and patient in the position of "you don't know what you don't know". Dr Seine said standard incisions had a high failure rate, and cutting out the same cancer a second time is less effective whatever method is used.
New Zealand has about 20 Mohs surgeons, and most of the work is done privately because Mohs is largely unavailable in public hospitals, he said.
What Southern Cross will fund
Southern Cross's published criteria, effective 17 December 2025, say it will only reimburse Mohs surgery when all three of these apply:
- The surgeon is accredited. The dermatologist must be accredited as a Mohs surgeon by the Australasian College of Dermatologists or the American College of Mohs Surgery, or have equivalent recognition.
- The cancer type qualifies. The lesion must be a basal cell carcinoma (BCC) or squamous cell carcinoma (SCC).
- The lesion meets one of two tests. Either:
- it has come back, has aggressive pathology or is clinically high risk, and is on the head or neck or on a site of earlier radiation or burn scarring; or
- it is on the eyelids, around the eyes, ears and the skin immediately in front of and behind the ears, lips, nose, chin, jaw, temple, fingers, toes or genitals, and keeping tissue is critical for function, shown with clinical photos.
Dr Seine said the insurer broadened access after the society raised concerns.
Benefit limits are the bigger problem
Dr Seine said the bigger issue now is that most policies cap the skin lesion benefit. Mohs used to sit outside that cap. Since April, he said, patients have had to choose between Mohs and less effective treatment based on how much they have left under their policy.
Specialists were telling patients about funding shortfalls every day, in some cases thousands of dollars, he said. Older patients who need three or four surgeries a year often found only the first was covered.
"It is a real issue when you start compromising your decisions on health care based on money," he told RNZ.
What Southern Cross says
Southern Cross spokesperson Regan Savage told RNZ in October the criteria focus Mohs cover on cases where there is a clinical need, so members for whom the surgery matters most keep access.
"Where the Mohs eligibility criteria are not met, standard surgical excision remains available as an established treatment for skin cancer, subject to the member's policy," Savage said. The criteria are reviewed regularly as practice and evidence change, he said.
Before you book treatment
If a doctor finds a skin cancer and suggests Mohs:
- Ask your specialist whether your lesion meets the Southern Cross criteria above, if you are with Southern Cross.
- Check your policy for a skin lesion limit and how much of it you have already used this year.
- Ask the insurer what it will pay before treatment, and get the specialist's quote in writing so you know the gap.
- If you are with another insurer, ask for its rules. This article covers Southern Cross's published criteria only.
Sources
- www.rnz.co.nz: skin cancer patients pushed towards less effective treatment by insurance shortfalls
- Southern Cross eligibility criteria (PDF)
For related reporting, browse our health coverage.
