Media releases 2014


Top health insurance claim $104,000

Tuesday, 22 April 2014 by Aimee Bourke

In the last calendar year Southern Cross Health Society paid out $659 million on 2.3 million health insurance claims – 154,000 of these for surgical procedures.

The top five claims paid out ranged from $104,000 for complex spinal surgery to $87,000 for a complex colectomy.

Peter Tynan, Southern Cross Health Society Chief Executive, says these prices reflect the difficulty of the surgeries being undertaken in private hospitals and the investment in facilities and nursing training for treating higher-risk patients.

“These are the extremes, but they serve to highlight just how the costs of surgery can stack up and what a valuable safety net health insurance can be. Imagine trying to find $100,000 out of your own savings – not many of us have those sort of funds available.”

In fact the majority of New Zealanders grossly underestimate the cost of surgery. Research carried out by Southern Cross in 2013 shows that the perception of what people think common procedures cost and the reality can be quite different.

  • 58% thought endometriosis surgery cost under $1,000 (costs start from $6,000)
  • 57% thought a knee replacement cost under $10,000 (costs start from $19,000)
  • and 67% thought open heart surgery cost under $15,000 (costs start from $43,000)

Tynan says that while 93% of the claims paid were non-surgical, the 7% that were surgical represented 75% of claims costs.

Those with the five highest claim payments were aged from 51 to 69 years, underlining the heightened demand for health services people have as they age. However Tynan points out that three of the five highest claims were for people who hadn’t reached the retirement age.

“People think of hip and knee replacements as something for elderly people, but it’s not uncommon to have those in their 40s and 50 undergoing bi-lateral (both sides) knee and hip surgeries.”


Top surgeries funded by Southern Cross Health Society for the 12 months ended 31 December 2013



Spinal surgery


Whipples procedure (major surgery on the organs)


Spinal surgery x 2


Herniated disc removal


Colectomy surgery



Editor Note:
For many Southern Cross policies there is a limit of $100,000 per surgical procedure. In some instances, several surgical procedures can be required per condition. This means that even if a member has a policy with a $100,000 surgical limit, a single claim and the amount reimbursed can exceed this amount for one condition.