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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The Insurance Advice We Give

With over 30 years of experience in the insurance field, our team specialises in problem-solving to ensure your financial independence remains intact during unexpected events and especially during challenging health situations.

In partnership with professionals and your own personal insight, along with trusted Solicitors and Accountants, we can create secure financial structures around your assets, ensuring your long-term plans are safeguarded.

When facing the uncertainties of disablement due to medical conditions, your reliance on earned income can be severely threatened. Maintaining your financial independence and funding amidst health challenges is paramount for your goals and your future. Here are the key factors we focus on to establish and regain control when faced with the disablement process:

1. Swift Access to Medical Support: Private medical insurance ensures immediate access to necessary medical advice, treatment, and technology without delay, providing peace of mind during critical times.
   
   
2. Control Your Debt Arrangements: We can help you be able to continue to service your loans in the early stages of disablement, reducing them significantly if your health continues to deteriorate and finally eliminating all debts in the event of your untimely impending or actual departure. This is where monthly mortgage repayment cover fits, along with lumpsums that pay out when a critical illness/condition is diagnosed, or if your disability becomes permanent.
   
   
3. Securing Artificial Income: Your ability to access a source of income becomes invaluable when earning your own living becomes impossible. This is where income protection fits, providing a stable source of income, enabling you to support dependents, completing retirement savings, and covering daily living expenses, ensuring your long-term projects stay on track.
   
   

Navigating the disablement process can be unpredictable, and it needs a more thorough set of appropriate structures and advice than many people think. By establishing proper structures, seeking expert advice, and selecting suitable insurance options, you regain control. Once control is regained, the Consolidation Stage begins as life continues, allowing your life to be addressed, resourced and funded as it continues.

The truth is that a holistic approach to the disablement process is necessary because, in our experience, the process is never predictable and never unfolds as you might expect. With our long term structured approach and comprehensive claims management we can ensure that your debt payments are met, solvency is established and ongoing needs are provided for. This can involve a complex claims process with multiple steps, which our service helps navigate for you. We take into account every facet of your needs from the lens of experienced industry professionals and help provide you with what you actually need at claim time, with no mistaken assumptions.

We specialise in a personalized approach, tailored to your unique situation. Let's meet to assess your current situation, evaluate existing resources, and discuss tailored solutions. We can and will also review Allied Professional Advice, existing structures like wills, trusts and guardianships, ensuring you and your dependents are well-prepared for the future.

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The Benefits of Using an Insurance Broker

1. Insurance Mistakes Can be Costly.

While we can sometimes think of insurance as being a simple matter, it can no doubt be a complicated prospect and the costs of getting things wrong can be high. If you don't have the right amount of cover you could be left unable to service your debt if something goes wrong, or people who depend on you could end up in trouble or out of pocket. In our years of professional experience, we've come across people who've filled out forms incorrectly, chosen the wrong type of insurance entirely, or overlooked a crucial detail, leaving them in a much worse situation when they need their claims.

Nearly all of these mistakes could have been avoided by consulting with a professional adviser. Insurance brokers take the time to assess what you really need and guide you through the process, eliminating unneeded costs, getting you the right insurance, making sure your real needs are covered and getting those forms 100% correct every time.

2. Your Claims Processed Stress Free

If you need to make a claim on your insurance, chances are you are going through one of the most stressful times of your life. During this time, processing claims, filling out forms and making sure everything is squared away is a true hassle, and one that you really can't afford to get wrong. Our Insurance service includes full claims management and support, helping you fill out forms correctly, guiding you every step of the way and making sure you get your claim processed as you need it every single time.

You don't need any more stress in your life, and making the choice to use an insurance broker to source your cover will take this claims stress out of your hands.

3. The Insurance Marketplace Can Change

The insurance market in New Zealand is ever-changing. New products and providers come and go, and the best insurance for your situation one year could be very different to the best insurance for you the next year. An insurance broker will conduct regular reviews of your insurance to make sure that what you're getting is still the best deal for you. If it is found that it's not, you'll be able to change to continue to get the best cover at the lowest prices. The best way to keep on top of the market and always get the best is to have a professional insurance broker in your service.

4. Zero Cost and Zero Obligation.

All the service that an insurance broker provides for you, from giving advice to sourcing your insurance, to conducting reviews and providing ongoing support, is entirely 100% cost free. All you pay for is your insurance premiums. Your insurance broker is paid by the insurance companies themselves at no additional cost to you, so you have nothing to lose by consulting one.

5. Better Deals Than Going It Alone   

In many cases, a reputable insurance broker can leverage their solid relationships with New Zealand's insurance providers to secure you better terms and/or better rates than you could find by going it alone. A broker can also get you indirect savings in cutting out aspects or benefits that you don't need and setting your sums assured at the level you need and not too far in excess of it. When combined with all the other benefits, we believe that taking the time to consult with an insurance broker is a no-brainer.

6. The Knowledge and Experience You Need

Our insurance team has over 100 years of combined experience in the insurance field. That's over a century's worth of knowledge and experience that they bring to help clients get the best and deal with anything that could arise. That knowledge is simply invaluable in crafting your insurance policy, maintaining it and making sure that it works the way it needs to and only the way it needs to. Alone, you could be at risk but with 100 years of experience behind you, you will be secure.

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When Insurance Works - Our Recent Claims

Insurance is sometimes regarded as protecting against something that's never really going to happen to us. We can however assure you that couldn't be further from the truth. We help manage our clients' claims all the time and we see that critical illness is a real and ever present danger. We've in the past had 16 claims in a single month, and we manage several dozen long term claims, some that have been running for as long as nine years.

Here is a section of our processed claims during 2013. 

Trauma/Critical Illness Claims

1. Bowel Cancer.
2. Loss of Hearing
3. Breast Cancer
4. Leukaemia
5. Cancer (Undefined)
6. Cancer (Undefined)
7. Cancer (Undefined)
8. Parkinson's Disease 

Income Protection Claims

1. Mental Health
2. Severe back Injury
3. Chemical Sensitivity
4. Automobile Accident
5. Stroke
6. Post concussion syndrome.
7. Back Injury
8. Heart failure/Cardiomyopathy
9. Lung Cancer
10. Prostate Cancer
11. Stroke
12. Hand Injury/Surgery
13. Wrist Injury/Surgery
14. Mental Health
 

Life Insurance Claims

1. Cardiac Condition
2. Cancer (Undefined)
3. Cardiac Arrest
4. Cancer (Undefined)
5. Bowel Cancer
6. Cardiac Arrest
7. Cancer (Undefined)
 

Permanent Disability Cover (TPD) Claims

1. Pneumococcal Meningitis
2. Post Concussive Epilepsy
3. Severe Hip Injury

Other Claims

1. Business Overheads Cover: Hand Injury/Diverticulities
2. Waiver of Premium: Back/Neck Injury

Sometimes, clients are unaware of the conditions of their cover and don't make a claim when they in fact, could. We're here anytime to take a look for you and answer all your claims questions as well as manage your claims and take the stress out of your hands. If you need help with any claims issues, don't hesitate to get in contact with us anytime. 

Have any claims or insurance questions you have answered anytime.

Our Unique Claims Service

If there is one aspect of our service we value above all else, it is getting our clients insurance claims through effectively, quickly and with the least stress possible.

Claim time, even when considered in the absence of the health or illness circumstances surrounding it, is an extremely stressful time. A time that is not helped by a panoply of forms, questions and going back and forth with insurance companies.

Whether you require pre-approval, a claim on your health insurance for a procedure, income protection after being rendered unable to work or in the worst case scenario, a claim for a critical illness or death, our professional team is there to help and support you. We have experience and a perfect record in getting the claims you need through and managing your claim for you during any crisis on an ongoing basis. We will arrange the necessary forms, get them to you, help you fill them out and then have them processed. We will then administer and take command of the claims process, always keeping you informed of what is happening.

Also, in our experience, clients can also be missing out on claims they could be receiving through a poor understanding on their own policies or the terminology of insurance providers. We can also help you with this, discerning for you precisely when you can claim and how much for.

If your claim is a single lump sum, our Head of Practise will personally visit you to assist with completing the forms and fully working through the claim with you, giving you personal expertise and one to one service to take the stress away. If you become one of our valued clients, we offer to you all the resources to help you at claim time and manage the difficulties in the easiest and most effective manner.

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