Working together to help members declined by ACC

Friday, 6 March 2015 by Kelsey Fletcher


Every month about 200 members ask Southern Cross to pay for surgery related to an accident that ACC has declined to fund. These requests are then investigated by the Southern Cross ACC team to see if a review is worthwhile for the member. The Southern Cross ACC team also considers and reviews treatment injury claims and decisions, which includes general surgery.

In the 2014 financial year, Southern Cross worked with 319 members to seek review from ACC, resulting in a cost recovery of $1.7 million. An additional $83,000 was made in savings for treatment costs that we did not fund because the review was successful before the members’ surgeries took place. Shoulder and knee injuries continue to make up the majority of review cases we assist our members with.

We also identified $2.8 million that had already been paid for healthcare services more appropriately classed as ACC treatment injury claims. Upon request, this was reimbursed to Southern Cross by ACC.

Further, Southern Cross saw savings of $244,000 where the procedure was identified as an ACC treatment injury before payment was made.

Here are some of the comments we’ve received from Southern Cross members.

“It was easy for us, as Southern Cross coordinated all the information required. We just had to give them what we had and they did the rest. We also had a very good outcome from the process.”

“I suffered for nearly five years with my back problem and once I became a member of Southern Cross I finally had the support and backing to get my problem solved. The result could not be better.”

Southern Cross Health Society ACC Clinical Manager, Kristin Rewha-Langdon says the team relies on the hard work and commitment of providers.

“We appreciate those who put together candid reports of their clinical opinion, we rely on that,” she says. “We continue to require their feedback and clinical opinion - a huge part of the review success is providers being prepared to report on that opinion.”