Small people making big claims
Not-for-profit health insurer Southern Cross Health Society funded 215,711 specialist appointments and procedures for children and young adults in 2015 – with the more expensive claims topping $50,000.
Southern Cross are releasing this information to improve transparency after research showed that many Kiwis are unaware about the costs of healthcare.
Most expensive individual children’s claims in 2015:
|Age: 0 - 4||Paid||Age: 5 - 9||Paid|
|Femur alignment||$25,697||Cystectomy and bladder reconstruction||$23,953|
|Hernia Repair||$18,686||Cortical mastoidectomy||$18,281|
|Abdominal wall access||$16,545||Nasal surgery||$14,861|
|Ureter reimplantation||$14,234||Modified radical mastoidectomy||$14,694|
|Age: 10 - 14||Paid||Age: 15 - 20||Paid|
|Colon removal||$32,156||Hip preservation||$54,184|
|Hip preservation||$31,739||Aortic valve replacement||$53,809|
|Radiofrequency ablation with cryotherapy||$29,150||Craniotomy||$43,804|
|Dislocation vs arthroscopy||$27,998||Craniotomy||$35,637|
|Kidney removal||$26,784||Arthroscopy - Wrist||$34,841|
|Age: 0 – 4||Price||Age: 5 - 9||Price|
|Simple Bilateral Ear Procedure||$1,900 - $2,600||Tonsillectomy||$3,600 - $4,600|
|Tonsillectomy||$3,600 - $4,600||Simple Bilateral Ear Procedure||$1,900 - $2,600|
|Adenoidectomy||$3,100 - $3,400||Removal of Teeth||$2,300 - $4,900|
|Hernia - Inguinal Repair||$5,800 - $7,450||Circumcision||$3,900 - $5,300|
|Circumcision||$3,900 - $5,300||Adenoidectomy||$3,100 - $4,100|
|Age: 10 - 14||Price||Age: 15 - 20||Price|
|Removal of Teeth||$2,300 - $4900||Removal of Teeth||$2,300 - $5,400|
|Tonsillectomy||$3,600 - $4,600||Tonsillectomy||$3,600 - $4700|
|Excision Skin Lesion||$3,500 - $4,900||Endometriosis Surgery||$9,700 - $13,300|
|Exposure of Unerupted Tooth||$1,400 - $2,700||Gastroscopy||$2,100 - $2,400|
|Gastroscopy||$2,000 - $2,400||Excision Skin Lesion||$3,600 - $5,000|
While procedures such as tonsillectomies and grommet insertion were common, what was surprising was the range and seriousness of some of the procedures says Head of Provider Networks Geoff Searle.
“While GP visits are free for children under 13, this is proof that childhood conditions can often require specialist intervention,” says Searle.
“No parent would want their child to remain untreated any longer than necessary. But we have to acknowledge that kids without life threatening conditions often wait to get treated on public lists - this is why children make up such a large amount of the Southern Cross membership.”
Southern Cross has 191,975 members who are under 21 – equalling 23% of the total membership.
As a not-for-profit, Southern Cross Health Society has a responsibility to add value for our members.
The Society manages the inflation of medical procedures through their Affiliated Provider programme - where specialists surgeons and facilities are contracted to provide Southern Cross Health Society members with certain procedures at agreed prices, and who streamline the prior approval and claims processes.
Southern Cross cover pre-existing conditions for new born children added to a policy within three months.Those who already have a policy with Southern Cross can receive a child’s rate for their first two children, with third and subsequent children covered for free until age 21.