From July 17 Southern Cross Health Society will be introducing or enhancing a number of member benefits as well as expanding its Affiliated Provider programme, now in its twentieth year.
The changes are the result of Southern Cross’ regular policy update process.
Southern Cross Head of Member Services Anthony McPhail says this latest update will see new cover added for 13 technologies, including Transoral Robotic Surgery (TORS), Endoscopic Ultrasound, Digital Breast Tomosynthesis (DBT) and Transcatheter Aortic Valve Implantation/Replacement (TAVI)*.
“We know that advances in medical technology can significantly improve health outcomes for our members. Our health service providers regularly submit procedures for us to prioritise and assess. Once we’ve done that, and confirmed the technology can improve patient outcomes at an acceptable cost, we can proceed with introducing cover.”
The expansion of Southern Cross Health Society’s Affiliated Provider Programme from 17 July 2017 will also bring benefits for the Society’s 830,000 members.
Affiliated Providers are doctors, specialists and facilities that work with Southern Cross Health Society to provide services at agreed prices for our members.
Southern Cross Head of Provider Networks Rebecca Ogilvie says the programme helps the Society keep rising healthcare costs in check and makes the prior approval and claiming process simpler for members.
“The positive impact on our members’ experience is significant,” she says. “There’s no need for them to pay upfront or fill out claim forms and wait for reimbursement at what can be a stressful time.”
The programme has been in place since 1997 and its expansion will see specialist consultations and imaging, such as x-rays and ultrasounds, become Affiliated Provider-only healthcare services.
A number of other procedures** will also become Affiliated Provider-only.
Last financial year the programme delivered more than $370 million in healthcare services which members didn’t have to pay upfront for and then claim back themselves. It’s also estimated that it moderated rising healthcare costs for our members by around $6.6 million***.
Already, around 60 per cent of all Southern Cross claims costs come through Affiliated Providers and, nationally, the Society has 1100 Affiliated Provider agreements with around 1600 practitioners working across 20 specialties.
Around 80 per cent of specialist consultations, by volume, also already go through Affiliated Providers.
“The expansion of the Affiliated Provider programme is about Southern Cross continuing to work with healthcare providers to ensure a robust, affordable and sustainable private healthcare sector for New Zealanders into the future,” Ms Ogilvie says.
* (Eligibility Criteria Apply)
Transoral Robotic Surgery (TORS)
TORS uses an operating robot to remove tissue from the throat through the mouth. It results in a significant reduction in morbidity compared to the open approach and is standard practice internationally.
This uses an endoscope with an ultrasound probe on the end to allow visualisation of internal structures from within the body. Through this method, all the layers of these internal structures are visualised, helping with the diagnosis, staging and tissue sample of tumours.
Digital Breast Tomosynthesis (DBT)
This is performed using the same scanner as a mammogram but takes multiple images of the entire breast to provide a three-dimensional view. This advanced imaging provides better visualisation of breast malignancy and improved distinction between breast lesions and normal tissue. Cover is available for diagnostic, rather than screening, purposes but if an abnormality is found during screening, the procedure will be treated as diagnostic.
Transcatheter aortic valve implantation/replacement (TAVI/TAVR)
This is a less invasive alternative to an open aortic valve replacement.
** All specialties
• all specialist consultations
• cardiac tests performed by a specialist (eg ECG)
• functional endoscopic sinus surgery (FESS)
• nasal cautery performed by a specialist
• complex aural toilet performed by a specialist
• prostate biopsies
• resection of bladder tumour
*** This represents the additional claims costs that would have been incurred by members for procedures undertaken within the Affiliated Provider programme if they had been subject to the prevailing rate of medical cost inflation for services done outside the programme.