The Importance of Medical Insurance: A $169,000 medical claim case study

In the unpredictable journey of life, unforeseen medical emergencies can quickly become financial disasters. Private Medical/Health Insurance is invaluable to have when faced with the exorbitant costs associated with comprehensive healthcare and getting you back on your feet. Spratt Insurance Brokers recently processed a medical insurance claim that exemplifies the significance of having adequate coverage, providing a stark reminder of the potential financial devastation without it, one of the highest claims ever processed by our agency (specifics and personal details have been withheld). The claim in question involved a myriad of medical and surgical procedures, a hospital stay, recovery and scans each carrying a substantial price tag. The breakdown of the expenses serves as a testament to the diverse and expensive nature of the care you may need at any time that you may not be able to afford out of your own pocket:

• Firstly, a Magnetic Resonance Imaging (MRI) was performed, incurring a cost of $2,870. This diagnostic tool is crucial for detailed imaging and diagnostics, but its expense highlights the financial challenges patients may face without insurance coverage.
• A Computed Tomography (CT) scan came with a price tag of $850. These imaging techniques are essential for accurate diagnosis and treatment planning.
• The heart of the claim lay in the surgeon's fee, a whopping $58,650. Life-saving surgical interventions can be financially crippling without insurance, making it clear that comprehensive coverage is indispensable in times of medical crisis.
• Intensive Care Unit (ICU) expenses amounted to $2,405.01, underlining the fact that even brief stays in specialized units can lead to astronomical bills. The peace of mind offered by medical insurance becomes apparent as it shields individuals from such financial strain during critical periods of recovery.
• The anaesthetist fee, totaling $30,797, showcases the multifaceted costs associated with surgical procedures.
• Implants, costing $5,995.61, and hospitalization expenses, including room and medical supplies, amounted to a staggering $68,000.26.

Spratt Insurance Brokers, understanding the significance of robust coverage, ensured that the entire medical bill of $169,567.88 was paid in full. This example serves as a poignant reminder of the financial protection that medical insurance provides, alleviating the burden of healthcare expenses and allowing individuals to focus on recovery rather than financial distress. If you are interested in sourcing the best in medical insurance for yourself, your family or a group scheme, our professional adviser team would be happy to assist.

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Surgical Waitlists in NZ - Health Insurance

Surgical wait lists

Due to the effects of COVID, closed borders and a staff shortage, New Zealand is currently experiencing a crisis of long waitlists for elective surgeries in public hospitals. 

Moreover, they are now growing longer and longer with the increase in COVID and Flu cases in the winter months. Hospitals around the country have also slashed elective surgery theatre operations due to the pandemic. And even those that are scheduled, many are cancelled or deferred at the last minute as a result of staff illness or hospital bed shortages.

In early May the wait list had grown to 27,000 for planned, non-acute treatment, up from 8000 in February 2020 before the first Covid arrivals in NZ and subsequent lockdowns took hold. One Christchurch based surgeon said there are over 6000 people waiting for elective hip. Over a recent 8-week period he would have expected to have completed over a dozen hip or new operations – in reality he performed just one.

It is certainly true that the Private Health care system and hospitals aren’t immune from delays in the current taxing environment, but they still do provide much more certainty, which means a good private health insurance plan remains the best way to ensure that you get the treatment you need with the minimum possible delay if something goes wrong with your health. 

With numerous individual and group plans available for you, your family, your business or your employees, we can help you get covered at the best prices today with a free, no obligation consultation on your insurance needs. Don't get waitlisted, let us help today.

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Southern Cross to launch new health insurance for young people.

Some good news, following on the heels of our recent article on the benefits of getting insured while you're young: Southern Cross has announced the release of a new health insurance product for young people. Named the 'Wellbeing Starter' plan, it is an entry level plan based on extensive market research of 1,500 young adults and what they described their needs of a health insurance plan to be.

One of the main needs described was affordability, and Wellbeing Starter achieves this by excluding all coverage for orthopaedics, urology and gynaecology (unless these aspects are required for the treatment of cancers). Southern Cross state directly that this may not be the best plan once clients reach middle age, but its a great option while they're young and covers what young people deemed to be most important to them.

The Wellbeing Starter plan's benefits include $500,000 surgical cover, $100,000 cardiac cover, $60,000 cover for cancer treatments, including an additional $10,000 for non-Pharmac drugs. It also includes a  $40,000 prophylactic treatment allowance, $3000 for skin surgery. The plan will also cover 75% of GP and physio visits (up to $150), in response to the research which discovered that an everyday benefit was important for young people to have.

As more insurers become serious about reaching out to young people, the benefits of getting insured young will only increase. This is definitely a positive development in that regard, If you'd like to enquire about getting your health insured, you can request a free, no obligation quote at anytime. We may be able to secure you an even better deal on your premiums than you would find yourself.

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Taking medical 'rationing' off the table with health insurance.

Article courtesy of Good Returns.

Two friends have had cancer recently. I use the term “had” in the most optimistic sense. Because although they are both cancer-free, we simply don’t know how long that will last.

For one of my friends their case was similar to a case widely reported in the news media – the doctor has been told off by the Medical Council for not sending his patient for further tests sooner. The client, who fortunately remains alive, has diminished chances of recovering from their cancer because of the delayed detection.

Why does this happen?

Obviously, for the case reported in the media the patient felt strongly enough about it to make a complaint. They must have wondered why their care was not better. 

Is it malpractice?

We simply cannot know enough from the reports to tell, but it does seem like better care should have been taken, it also seems like the punishment handed out was very minor.

Is it just the odds?

Perhaps this is a fine question of judgement, a genuine edge case where the decision could have gone either way.

Is it a reasoned response to the risk of false positives?

As not everyone can be tested every year for every possible disorder some choices have to be made. In some cases there is the risk of false positives to consider, and some tests – like biopsies – carry health risks of their own.

Is it rationing?

That’s the fear: rationing. It’s hard enough coping with the idea of ill health, the possibility of a potentially fatal illness, without having to second guess your doctor – are they not sending me for that test because I don’t need it, or because of the cost to the state sector.

In both of my friend’s cases the immediate treatment once diagnosed was very good, it was just the question of getting a diagnosis.

Of course, the easiest way to take the risk of rationing off the table is to insure it. I’d want to insure it all and have every form of medical cover I can possibly buy – including cover for treatment overseas – but if you are working with a client at the other end of the spectrum, I’d at least get specialists and tests cover." 

In general, the public system does a fantastic job with what it has (as the article admits, the treatment itself is top drawer), but sometimes it just isn't enough and cases such as those described here will slip through the cracks. In my own case, I have seen the benefits of having health insurance when I was diagnosed with Crohn's Disease (full story here) and in my case, having tests and specialist cover as well as basic hospitalisation cover gave me a financial safety blanket and protected me from over $20,000 worth of costs, as well as securing me the best and most prompt treatment available from the private system.

Having the full range of health insurance options is a somewhat costly proposition and we do realise this (although it is no doubt a good thing to cover all your bases in terms of your health). However, there are cost effective and assuredly worthwhile options such as the one I have selected for myself; a combination of basic hospitalisation, surgical cover as well as tests and specialists. The premium is definitely affordable, and it has already, at the age of 27, paid off for me many times over. 

Overall, its always a good idea to take the possibility of delayed diagnosis and rationing off the table as well as protecting from the cost of unforeseen health issues. Don't hesitate to get in contact and let us take the legwork out of securing the health insurance that's right for you.

Email us today at enquiry@sprattfinancial.co.nz