Thursday, December 9

Bad endorsements top the list of the most expensive health insurance claims


Surgery for back problems has topped the list of costliest surgical claims funded by Southern Cross Health Insurance this year, with the largest claim reaching $ 222,000.

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Eight of the 10 most expensive claims paid by New Zealand’s largest health insurer were for spinal fusions, a surgery that permanently connects two or more vertebrae in the spine.

Southern Cross Medical Director Stephen Child said the nonprofit paid more than $ 1 billion ($ 1.12 billion) for more than three million claims for the year through the end of June.

“The most expensive individual claims were for major surgeries, but in terms of the volume of claims, the highest number was by far for cryotherapy. [freezing by liquid nitrogen] of skin lesions and other skin treatments “.

Covid restrictions had taken a toll on claims at some points, as people were unable to access treatment at level 4, he said.

“The Southern Cross Society promised members $ 50 million in the previous closing because it was not appropriate to take their premiums when we were unable to pay the claims due to the closing.

“There has been a minor drop in volumes with the most recent lock and what we also saw was a rebound increase in volumes when we came out of the lock.”

However, overall complaints were increasing every year, due in part to the aging of the population and also to screening programs, which were catching problems earlier.

“That’s a good thing, obviously, because it means that people are meeting their needs and we also have a greater awareness of things like skin cancer, for example.

“But at the same time, there is also a shortage of dermatologists, so it is difficult to have access to good skin care in the public sector. That is one of the reasons the private sector is doing more of this work. , complementing the good work of the public sector “. . “

For those people who did not meet the criteria for surgery in the public sector or who faced a longer wait, private health coverage allowed them to have surgery earlier, he said.

“Spinal operations are extremely expensive, but so are some major heart operations, breast cancer operations can cost more than $ 80,000, head and neck cancers can exceed $ 150,000.

“So there are some very high cost claims, hopefully rare, that people can have, and that’s where private insurance can really come to the fore, with those kinds of expenses.”

Top 10 Most Expensive Individual Claims for Fiscal Year 21

  • Spinal fusion $ 222,000
  • Spinal fusion $ 210,000
  • Spinal fusion $ 201,000
  • Spinal fusion $ 200,000
  • Spinal fusion $ 179,000
  • Spinal fusion $ 175,000
  • Radical neck dissection $ 170,000
  • Radical neck dissection $ 156,000
  • Spinal fusion $ 156,000
  • Spinal fusion $ 153,000

Top 10 Proceedings by Volume in Fiscal Year 21

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  • Cryotherapy of skin lesions Treatment with liquid nitrogen to freeze and destroy an abnormality. 34,000
  • Excisional skin injury Removal of abnormal tissue, usually related to cancer. 31,000
  • GP minor surgery N / A 26,000
  • Colonoscopy A test used to detect changes or abnormalities in the large intestine (colon) and rectum. 23,000
  • Intravitreal injection An injection or injection of medicine into the eye. 10,000
  • Nasendoscopy A test to look inside the nose, throat (pharynx), and larynx (larynx). 9,000
  • Skin and subcutaneous tissue biopsy A procedure to remove cells or skin samples from the body for laboratory examination. 9,000
  • Cataract extraction and IOL insertion Extraction of the cloudy lens in the eye and replacement with artificial intraocular lens (IOL). 8,000
  • Gastroscopy (+/- Biopsy / Polyp) Procedure to examine the upper part of the digestive system. 7,000
  • Tooth extraction N / A 6,000


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