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.
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.
Healthcare services approved through our health technology assessment process as approved treatment.
Please note: These healthcare services have been approved through our health technology assessment process but are not yet included in policy documents (where relevant). Eligibility criteria and terms and conditions apply, this may include Affiliated Provider restrictions (not all healthcare services are available from all Affiliated Providers or in all areas) and prosthesis and specialised equipment limits (except on UltraCare). To find out if you will be covered for a particular healthcare service you can contact us or your Affiliated Provider.
- 3D low-dose, weight-bearing X-ray (e.g. EOS imaging)
- Abbreviated breast MRI
- Botulinum toxin for laryngeal dystonia
- Bulkamid- Periurethral bulking agent for urinary incontinence. A prosthesis maximum of $3,000 applies.
- Cardiac technician fees for management of appliances or devices (including pacemakers)
- 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). A prosthesis maximum of $10,250 applies.
- Intravascular lithotripsy for coronary artery disease
- Laparoscopic liver resection/hepatectomy
- Liposuction for secondary lymphedema following an oncological intervention
- Liver elastography (e.g. Fibroscan)
- Methylene blue injections (for anal pruritus)
- Multi-level cervical disc replacement
- Pacemaker (initial appliance) Except for Lead-less pacemaker (Medtronic Micra)
- A prosthesis maximum of $2,760 applies for a single chamber pacemaker
- A prosthesis maximum of $4,485 applies for a dual chamber pacemaker
- A prosthesis maximum of $10,260 applies for a Biventricular/complex pacemaker
- Peripheral sensory nerve ablation for cancer-related pain
- Pressurised intraperitoneal aerosol chemotherapy (PIPAC)
- Per Oral Endoscopic Myotomy & Zenker's peroral endoscopic myotomy (POEM and ZPOEM)
- Robotic orthopaedic surgery (including total or partial knee arthroplasty using Stryker Mako, Zimmer Biomet ROSA, Smith and Nephew NAVIO or Johnson & Johnson VELYS)
- Single fibre electromyogram (SFE)
- Thyroid nodule ablation
- Temporomandibular joint (TMJ) replacement
- A prosthesis maximum of $26,000 applies for unilateral
- A prosthesis maximum of $45,000 applies for bilateral
- Transcoronary ethanol septal ablation (TESA) also known as Transcatheter ethanol septal ablation
List of unapproved healthcare services
Please note: The specialty headings used below are inserted for convenience of reference only and in no way define, limit or affect the meaning or interpretation of the listed unapproved healthcare services. Further, 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.