Dodgy hips & knees among most common health insurance claims

Friday , 23 October 2020 by Susannah Walker

The country’s biggest health insurer paid out nearly $1 billion worth of claims in the year to 30 June 2020 with New Zealanders’ hips and knees proving costly.

Not-for-profit Southern Cross Health Insurance funded more than 1,800 knee replacement surgeries ($47.9m) and more than 1,900 hip replacement surgeries ($45m) in the 12-month period. These two procedures alone accounted for nearly 10 per cent of the organisation’s $972m in total claims paid.

Common claims sitecore 300x200Southern Cross Health Insurance Chief Medical Officer, Dr Stephen Child, said this data provides an important insight into the role of the private sector in meeting the health requirements of New Zealanders.

“While the public health system does a fantastic job looking after acute urgent medical issues, health insurance gives Kiwis access to elective surgical procedures and specialist consultations when they need it and choice about where they receive it,” said Child.

Southern Cross Health Insurance’s top claims show a heavy reliance on the private health sector to perform colonoscopies, which are used to look for signs of bowel cancer and investigate causes of pain, bleeding or changed bowel habits. The organisation funded nearly 20,000 procedures at a cost of $43.3 million.

Other top claims include removal of skin cancers and other skin lesions with Southern Cross Health Insurance funding more than 27,000 procedures to the tune of $34.5m.

For children, surgical removal of tonsils, teeth and adenoids topped the list of most expensive procedures with Southern Cross Health Insurance funding nearly 2,500 surgeries at a cost of more than $10m.

For women, hysterectomy and endometriosis surgery featured in their top 10 claims with nearly $22m paid to fund hysterectomies and $16m for endometriosis procedures.

The data also points to the significant role of private health providers enabling access to chemotherapy to treat cancer with Southern Cross Health Insurance members receiving $26m worth of treatment.

“Health insurance allows people swift access to quality treatment when it’s most needed,” added Dr Child. “Southern Cross Health Insurance funds close to half a million specialist consultations and a quarter of a million surgical procedures in the past year which helps to reduce the burden on the public health system.”

Southern Cross Health Insurance has more than 879,000 members which represent 61.5 per cent of New Zealanders that have health insurance, and it accounts for 71 per cent of all claims met by the New Zealand health insurance sector. Every day the organisation funds almost 12,000 health services or events.

Top 10 procedures/episode claims*

(based on Southern Cross claims data in the 12 months to 30 June 2020)

*The top 10 surgical procedures/episode claims exclude specialist consultations.