Unapproved healthcare services

What is an unapproved healthcare service?

An unapproved healthcare service is any drug, device, technique, test and/or other healthcare service that has not been approved by Southern Cross prior to treatment. Unapproved healthcare services are an exclusion and are not covered by Southern Cross. 

List of unapproved healthcare services

This is not an exhaustive list of unapproved healthcare services. We consider healthcare services which are alternative names for and/or are similar to those listed below to be unapproved healthcare services. 

To find out if you will be covered for a particular healthcare service you can contact us or your Affiliated Provider.

Why is a healthcare service unapproved?

A healthcare service may not have been approved by Southern Cross for one of the following reasons:
• The healthcare service has not been assessed for cover by Southern Cross
• The healthcare service has been assessed by Southern Cross and the decision made to exclude cover 

It is important Southern Cross balances the cover available under its policies with the cost to members, this means that not all healthcare services can be covered.

List of unapproved healthcare services

Cardiac

  • Covered Endovascular Reconstruction of Aortic Bifurcation (CERAB)
  • Drug-eluting balloon angioplasty
  • External counter pulsation therapy
  • Insertion of implantable cardiac event monitor (i.e. Reveal device)
  • Inspiris Resilia aortic valve
  • Intravascular lithotripsy for coronary artery disease
  • Minimally invasive aortic valve surgery
  • Mitral valve repair clip (i.e. Mitraclip)
  • Pacemaker (appliance)
  • Pacemaker surgery (other than the initial implantation)
  • Personalised external aortic root support
  • Sutureless cardiac valve and surgery (other than when the valve cost does not exceed the surgically implanted heart valve maximum as listed on the List of Prosthesis and Specialised Equipment)
  • Transcatheter aortic valve implantation, TAVI (other than when using the transfemoral approach)
  • Transcatheter ethanol septal ablation
  • Transcatheter tricuspid valve repair or replacement (i.e. TriClip, Cardioband, PASCAL)

Ear, nose and throat (ENT)

  • Cochlear implant (appliance)
  • Eustachian tube injections
  • Eustachian tube balloon dilatation
  • Intranasal phototherapy (i.e. Rhinolight)
  • Laser ear surgery (except for KTP laser mastoidectomy, KTP laser revision mastoidectomy, KTP laser tympanoplasty, KTP laser second look tympanoplasty, KTP laser middle ear adhesiolysis, KTP laser stapedectomy, KTP laser medial canalplasty, and KTP laser myringotomy)
  • Sleep apnoea surgery
  • Vidian neurectomy
  • VOX vocal cord implant

General surgery

  • BRAVA assisted breast reconstruction
  • Bulking agents including PTQ silicone microspheres
  • Colonic chromoendoscopy
  • Endobronchial ultrasound (EBUS)
  • Gastroduodenal artery embolisation
  • HALO radiofrequency ablation
  • Laparoscopic hepatectomy
  • Laser ablation of common bile duct stones
  • Lloyd release procedure
  • Methylene blue injections (for anal pruritus)
  • Peroral endoscopic myotomy (POEM)
  • Portal vein embolisation
  • Stretta
  • Transanal total mesorectal excision of the rectum (TaTME)
  • VenaSeal closure system for varicose veins
  • Video-assisted fistula tract/sinus ablation (i.e. VAAFT)

Gynaecology

  • Hymenorrhaphy
  • Labiaplasty
  • Laparoscopic ovarian vein clipping
  • Laser treatment for atrophic vaginal changes (e.g. MonaLisa Touch)
  • Laser treatment for incontinence (i.e. FemiLift)
  • MRI-guided ultrasound for ablation of uterine fibroids

Imaging

  • Abbreviated breast MRI
  • 123Iodine scan of the thyroid and whole body (Radioactive iodine uptake test, RAIU test)
  • 3D volumetric photography
  • Breast thermography
  • Carotid intima-media thickness test (CIMT)
  • Clinical photography
  • CT calcium scoring
  • Liver elastography (i.e. Fibroscan)

Interventional radiology

  • Adrenal vein sampling (AVS)
  • Basivertebral ablation
  • Bone tumour ablation and cementoplasty/vertebroplasty
  • Cryoablation of central and peripheral nerve
  • Percutaneous renal cryoablation
  • Renal aneurysm coiling
  • Renal artery denervation
  • Sclerotherapy, embolisation or clipping for pelvic venous congestion syndrome

Neurosurgery

  • Embolisation or surgery for cerebralvascular abnormality (including aneurysm)
  • Occipital neurectomy and denervation skull base

Oncology

  • Biozorb breast implant
  • Intraoperative radiation therapy (IORT)
  • Irreversible electroporation (e.g. Nanoknife)
  • Lutetium 177 PSMA radioligand therapy
  • Pressurised intraperitoneal aerosol chemotherapy (PIPAC)
  • Proton beam therapy
  • Rectal spacer (e.g. SpaceOAR Hyrdogel)
  • Selective internal radiation therapy (SIRT)
  • Transarterial chemoembolization (TACE) of hepatic tumours and drug-eluting bead TACE (DEB-TACE)

Ophthalmology

  • BlephEx treatment
  • Ellex 2RT ophthalmic laser (other than for the treatment of significant macular oedema)
  • Eyelid warming (e.g. Blephasteam, EyeGiene, MGDRx eye bag, LipiFlow)
  • Implantation of artificial iris
  • Insertion of implantable telescope (e.g. CentraSight)
  • Intense pulsed light (IPL) therapy for dry eye treatment
  • Micropulse transcleral cyclophotocoagulation (mpTSCPC)
  • Microstents for the treatment of glaucoma (i.e. Glaukos iStent, Ivantis Hydrus)
  • Neural vision correction technology (i.e. NeuroVision therapy)
  • YAG laser for vitreous floaters

Oral surgery

  • Partial glossectomy using laser
  • Temporo-mandibular joint replacement

Orthopaedic surgery

  • Balloon kyphoplasty
  • Bone tamp
  • Cementoplasty/Vertebroplasty
  • Chitosan-based biomaterial (i.e. BST-CarGel)
  • Collagen nerve wrap (i.e. Neuragen nerve guide)
  • Great toe arthroplasty
  • Hyaluronic acid injection (i.e. Durolane injection, Synvisc injection)
  • Image-guided percutaneous trigger finger release
  • Interspinous dynamic stabilisation
  • Laser treatment of ingrown toenails
  • Lumbar/thoracic disc replacement
  • Multi-level cervical disc replacement
  • Osteochondral autografts (OATS procedure)
  • Robotic orthopaedic surgery (including total knee arthroplasty or partial knee arthroplasty using Stryker Mako, Zimmer Biomet Rosa, Smith and Nephew Navio)
  • Sinus tarsi spacer for posterior tibialis reconstruction surgery
  • Spinal cord stimulator implant (SCS)
  • Subtalar implants (i.e. ProStop, BIOARCH)
  • Thermosensitive hydrogel (i.e JointRep)
  • Ultrasound-guided percutaneous carpal tunnel release

Plastic surgery

  • Abdominoplasty and/or repair of rectus divarication
  • Brow lift
  • Liposuction

Skin

  • Intralesional cryotherapy
  • Laser treatment of skin lesions/conditions
  • Microwave therapy for the treatment of axillary hyperhidrosis (e.g. MiraDry)
  • Photodynamic therapy
  • Phototesting for light sensitive dermatological disorders

Tests

  • Cxbladder test
  • Hepatic venous pressure gradient test (HVPG)
  • InflammaDry MMP
  • Liquid biopsy (i.e. Guardant, Exact Sciences)
  • Prenatal tests (except for amniocentesis, maternal serum screening, triple X test and chorionic villus sampling)
  • Saline suppression test
  • Tilt table test
  • Video head Impulse test (vHIT)

Urology

  • Allium Prostatic stent
  • Microwave ablation of renal tumours
  • Percutaneous tibial nerve stimulation
  • Periurethral bulking agent for urinary incontinence (i.e. Bulkamid)
  • PrecisionPoint transperineal prostate biopsy
  • Prostatic urethral lift surgery (e.g. Urolift)
  • Renal dialysis
  • Resonance metal ureteric stent
  • Sacral Nerve Stimulation for bladder disorders
  • Water vapour therapy for benign prostatic enlargement (e.g. Rezum)

Urology

  • Cryoablation for vascular malformation

Other

  • Acellular Dermal Matrix/biological mesh (except when used in breast reconstruction, rotator cuff repair, gastrointestinal surgery, gynaecological surgery, and head and neck surgery)
  • Blood injections/transfusions/infusions (except when used for chemotherapy treatment)
  • Bone and soft tissue tumour ablation
  • Botulinum toxin injections, i.e. Botox, Dysport (except when used in the treatment of anal fissures or the bladder or urethra)
  • Colonic irrigation
  • Custom made prosthesis
  • Deoxycholic acid injection (i.e. Belkyra injection)
  • Ex-Ablate system
  • Extracorporeal shock wave therapy (other than for lithotripsy for the treatment of kidney stones)
  • Fat grafting and fat grafts (except when used for an eligible breast reconstruction surgery, or as part of eligible ENT, oral, orthopaedic and neurosurgical procedures)
  • Hilotherapy
  • Hyperbaric oxygen therapy
  • Oolo-Austin Trigenics
  • Platelet-rich plasma injections
  • Radiofrequency neurotomy (except for thermal radiofrequency neurotomy of the medial branch nerves of the spine)
  • Stem cell therapy
  • Therapeutic phlebotomy / Therapeutic venesection