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?

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.

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.

List of healthcare services which have been approved and will be included in policy documents (where relevant) at the next policy update.

  • Abbreviated breast MRI
  • Botulinum toxin for laryngeal dystonia
  • Drug-eluting balloon angioplasty for in-stent restenosis
  • Eustachian tube balloon dilatation
  • Image-guided percutaneous carpal tunnel release
  • Image-guided percutaneous trigger finger release
  • Implantation of prosthetic iris device (including custom-made artificial iris)
  • Intravascular lithotripsy for coronary artery disease
  • Laparoscopic liver resection/hepatectomy
  • Pacemaker appliance (initial appliance) 
  • Peripheral sensory nerve ablation for cancer-related pain
  • Pressurised intraperitoneal aerosol chemotherapy (PIPAC)
  • Robotic orthopaedic surgery (including total or partial knee arthroplasty using Stryker Mako, Zimmer Biomet ROSA or Smith and Nephew NAVIO)
  • Temporomandibular joint (TMJ) replacement 
  • VOX vocal cord implant 

Eligibility criteria and terms and conditions apply. Please contact us for further information. 

List of unapproved healthcare services

Cardiac

  • External counter pulsation therapy
  • Insertion of implantable cardiac event monitor (e.g. Reveal device)
  • Inspiris Resilia aortic valve
  • Minimally invasive aortic valve surgery
  • Pacemaker surgery (other than the initial implantation)
  • Personalised external aortic root support (PEARS)
  • 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 Prostheses and Specialised Equipment)
  • Transcatheter aortic valve implantation (TAVI) (other than when using the transfemoral approach)
  • Transcatheter ethanol septal ablation
  • Transcatheter mitral valve repair or replacement (e.g. MitraClip, PASCAL) 
  • Transcatheter tricuspid valve repair or replacement (e.g. TriClip, Cardioband, PASCAL)

Ear, nose and throat (ENT)

  • Cochlear implant (appliance)
  • Eustachian tube injections
  • Intranasal phototherapy (e.g. Rhinolight)
  • Insertion of LATERA nasal implant
  • 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

General surgery

  • Anti-reflux mucosal ablation (ARMA)
  • BRAVA assisted breast reconstruction
  • Breast Reconstruction (except when following an eligible Mastectomy)
  • Bulking agents including PTQ silicone microspheres
  • Colonic chromoendoscopy
  • Endobronchial ultrasound (EBUS)
  • Gastroduodenal artery embolisation
  • Laser ablation of common bile duct stones
  • Lloyd release procedure
  • Methylene blue injections (for anal pruritus)
  • Portal vein embolisation
  • Stretta procedure
  • Transanal total mesorectal excision of the rectum (TaTME)
  • Video-assisted fistula tract/sinus ablation (e.g. VAAFT, VAAPS)
  • Peroral endoscopic myotomy (POEM) or Z-POEM (Zenker's peroral endoscopic myotomy)

Gynaecology

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

Imaging

  • 123Iodine scan of the thyroid and whole body (Radioactive iodine uptake test, RAIU test)
  • 3D volumetric photography
  • 3D low-dose, weight-bearing X-ray (e.g. EOS imaging)
  • Breast thermography
  • Carotid intima-media thickness test (CIMT)
  • Clinical photography
  • CT calcium scoring
  • Liver elastography (e.g. Fibroscan)

Interventional radiology

  • Cryoablation of central or peripheral nerve
  • Renal aneurysm coiling
  • Renal denervation (RDN)
  • Sclerotherapy, embolisation or clipping for pelvic venous congestion syndrome

Neurosurgery

  • Embolisation or surgery for cerebrovascular 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
  • Proton beam therapy
  • Rectal spacer (e.g. SpaceOAR Hydrogel)
  • Selective internal radiation therapy (SIRT)
  • Transarterial chemoembolisation (TACE) or Drug-eluting bead transarterial chemoembolisation (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)
  • Insertion of implantable telescope (e.g. CentraSight)
  • Intense pulsed light (IPL) therapy for dry eye treatment
  • Micropulse transscleral cyclophotocoagulation (mpTSCPC)
  • Microstents for the treatment of glaucoma (e.g. Glaukos iStent, Ivantis Hydrus)
  • Neural vision correction technology (e.g. NeuroVision therapy)
  • YAG laser vitreolysis for vitreous floaters

Oral surgery

  • Partial glossectomy using laser

Orthopaedic surgery

  • Chitosan-based biomaterial (e.g. BST-CarGel)
  • Collagen nerve wrap/conduit (e.g. Neuragen nerve guide)
  • Interspinous dynamic stabilisation (e.g. Coflex, DIAM, Wallis, X-STOP)
  • Lumbar/thoracic disc replacement
  • Multi-level cervical disc replacement
  • Osteochondral grafting (e.g. OATS procedure, Mosaicplasty)
  • Sinus tarsi spacer for posterior tibialis reconstruction surgery
  • Spinal cord stimulator (SCS) implant
  • Subtalar implants (e.g. ProStop, BIOARCH)
  • Thermosensitive hydrogel (e.g. JointRep)

Plastic surgery

  • Abdominoplasty and/or repair of rectus divarication
  • Brow lift
  • Liposuction (except when used for an eligible breast reconstruction or revision surgery)

Skin

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

Tests

  • Cxbladder test
  • Hepatic venous pressure gradient test (HVPG)
  • InflammaDry MMP
  • Liquid biopsy (e.g. Guardant360, FoundationACT)
  • Prenatal tests (except for amniocentesis, maternal serum screening, triple X test and chorionic villus sampling)
  • Saline suppression test / Saline infusion test
  • Tilt table test

Urology

  • Allium prostatic stent
  • Percutaneous tibial nerve stimulation (PTNS)
  • Periurethral bulking agent for urinary incontinence (e.g. Bulkamid, Macroplastique)
  • Prostatic urethral lift surgery (e.g. UroLift)
  • Renal dialysis
  • Resonance metallic ureteral stent
  • Water vapour therapy for benign prostatic enlargement (e.g. Rezum)

Vascular

  • Covered endovascular reconstruction of aortic bifurcation (CERAB)
  • Fenestrated endovascular aneurysm repair (FEVAR)

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)
  • Botulinum toxin injections (e.g. Botox, Dysport) (except when used in the treatment of anal fissures or the bladder or urethra)
  • Colonic irrigation
  • Custom made prosthesis
  • Deoxycholic acid injection (e.g. Belkyra, Kybella)
  • ExAblate 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 or revision surgery, or as part of eligible ENT, oral, orthopaedic and neurosurgical procedures)
  • Hilotherapy
  • Hyperbaric oxygen therapy
  • Laser treatment of ingrown toenails
  • Laser haemorrhoidoplasty +/- mucopexy
  • Oolo-Austin Trigenics (OAT) procedure
  • Platelet-rich plasma (PRP) injections
  • Radiofrequency neurotomy (except for thermal radiofrequency neurotomy of the medial branch nerves of the spine)
  • Stem cell therapy
  • Therapeutic phlebotomy / Therapeutic venesection
  • Viscosupplementation / Hyaluronic acid injection (e.g. Intra-articular injection of Durolane, Synvisc, Sodium hyaluronate)