Advice matters
What Are The Most Expensive Health Insurance Claims?

Knee and hip replacements were top the list of recent claims for surgical procedures made by Kiwis, with a combined value of $ 94.7 million paid out by Southern Cross Health Society.

The two surgical procedures were in every region’s list of top five claims made to the insurer in the year to 31 March 2019, except Gisborne, where hip replacements didn’t make the top five.

The top five claims and total paid out between 1 April 2018 and 31 March 2019 were:

  • Knee replacements $47.4m
  • Hip replacements $47.3m
  • Colonoscopies $43.9m
  • Skin lesion removals $37.5m
  • Cataract extraction and insert $28.2m

The insurer stated that although only 8 percent (240,000 procedures) of all claims were for elective surgery, they accounted for 70 percent of overall claims costs, with the most expensive surgery coming in at $211,978, for a spinal fusion.

Southern Cross Health Society Chief Medical Officer, Dr Stephen Child, says that the not-for-profit provides cover for about 870,000 Kiwis, which is roughly 18 percent of the population, providing an insight into the health requirements of New Zealanders.

“Many conditions require very complex and expensive treatment. While we have a very good public health system in New Zealand, it’s under increasing pressure,” said Dr Child.

He said claims can differ greatly according to age and gender.

“We see a lot of claims for tooth extractions from those aged under thirty. As the age of our members increases, we see a lot more of the claims on our top five list – hip and knee replacements, colonoscopies, skin lesion removals, and cataract extraction and insertions,” he explained.

The Society’s Affiliated Provider programme has helped to keep rising healthcare costs in check.

Following the last financial year, the programme achieved $91 million in price-related savings over five years. The insurer noted that to calculate these estimated price-related savings, the impact on claims of utilisation and the addition of new benefits was identified and excluded.