Health insurance payouts top 800 million dollars

Tuesday , 26 May 2015 by Aimee Bourke

Figures released today show Southern Cross Health Society paid 2.3 million claims in the last calendar year with a combined value of $803.4 million.

Though just 7% or 163,370 of those claims were for elective surgery they accounted for 73% of costs. And like government figures, the number and cost of surgeries funded each year by Southern Cross keep climbing. For example, in the last five years Southern Cross has seen 23% growth in the number of surgeries funded and a 32% increase in the associated costs.

In 2014, five individual members of the not-for-profit health insurer were paid over $125,000 in medical claims. The top claiming policyholder was paid $157,832, with the following four receiving $139,954, $128,470, $125,002 and $124,966 respectively.

Peter Tynan, Southern Cross Health Society Chief Executive, says there are many conditions that require complex and expensive treatment.

“While we all hope we will never need these treatments, you just never know what’s around the corner and it highlights what a valuable safety net health insurance can be.”

Southern Cross’ most-claimed for procedures by dollar value were:

Imaging and tests - $70,630,799

Skin procedures - $41,677,389

Total knee replacements - $40,575,735

Total hip replacements - $38,170,366

Colonoscopies - $30,584,974

Tynan stressed that while the type of claims received vary greatly depending on age and gender, all ages benefit from having health insurance making it an investment from cradle to grave.

“We tend to see more tooth extractions for those aged under 30, for women aged 31-40 endometriosis surgery is predominant. And after 50 years of age hip and knee replacements, colonoscopies, cataract extraction and skin lesion removals are in high demand.”

The claims data also reinforced Southern Cross’ position as the industry leader in paying claims. In the last calendar year, for every dollar of premium, Southern Cross paid out over 90 cents in claims.

Tynan says, “Last year we paid 72% of the country’s health insurance claims, so we have a significant amount of data on what healthcare actually costs and what people actually claim for. Our policy benefits and limits are constructed with this knowledge in mind. It also means Southern Cross members get extremely good value for every dollar of premium they pay.”

Additional data: 2014 top 5 procedures by cost, age and gender