Zohreh Sajjad, a 49-year-old resident of Melbourne, is facing a critical health crisis as her insurance provider, Medibank, refuses to cover a potentially life-saving treatment for her aggressive cancer. Sajjad, who was diagnosed with lymphoma last year, has already undergone chemotherapy and radiation, but her condition continues to worsen. Her only hope now lies in CAR T-cell therapy, an innovative immunotherapy that modifies a patient's immune cells to target and destroy cancer cells.

However, the cost of this treatment is prohibitively high, exceeding $600,000 per round. Medibank claims that the specifics of Sajjad's policy exclude coverage for this treatment. As a result, Sajjad and her husband, Hossein Majlesi, may be forced to sell their family home to finance the therapy. "The medical team has clearly expressed that any delay in initiating CAR-T treatment poses a very serious risk to Zohreh's health and survival," Majlesi stated. "Zohreh's health and life are at stake, and urgent intervention is critical."

CAR T-cell therapy works by extracting T-cells, a type of white blood cell, from the patient’s blood. These cells are then genetically engineered in a laboratory to produce chimeric antigen receptors (CAR), which enable them to specifically target cancer cells while ignoring healthy ones.

Majlesi expressed frustration with Medibank, feeling that the insurer is using technicalities to avoid covering the treatment. "We're being forced to liquidate assets to save my wife's life," he said.

In a letter from Medibank, Sajjad and Majlesi were informed that CAR T-cell therapy is a highly specialized treatment available only to those eligible for Medicare. However, Sajjad is not eligible for Medicare benefits as she is not yet a permanent resident of Australia.

"When we enrolled with Medibank, they were fully aware that we were not permanent residents and explicitly included this in our policy," Majlesi explained. "The policy clearly states that all cancer treatments, including immunotherapy, radiotherapy, and chemotherapy, are covered. Meanwhile, we face selling our home to afford CAR-T therapy."

A spokesperson for Medibank stated that the company has been in regular contact with Sajjad and Majlesi regarding available treatment options. "We'll continue to support the customer with eligible treatments available through their health cover," the spokesperson said. "We wish her the very best with her ongoing treatment."

Due to their residency status, Sajjad and Majlesi have had to secure a private health insurance policy that mimics the coverage provided by Medicare for Australian residents. While Sajjad's policy states it covers chemotherapy, radiotherapy, and immunotherapy for cancer, it only applies to medical services where a Medicare benefit is payable. CAR T-cell therapy, however, is funded through the National Health Reform Agreement and does not fall under Medicare or the Pharmaceutical Benefits Scheme (PBS).

As the couple navigates this challenging situation, they are left grappling with the implications of their insurance coverage and the urgent need for treatment.