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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Notes from the Southern Cross Road Show 2013 (Part One)

Recently one of our team attended the Southern Cross Health Insurance Roadshow. Here is her experience from the event, and what the experts are saying about the current state of Southern Cross, health insurance in New Zealand, the private health care system and several forthcoming changes.

Lars Bojsen-Moller (Chief Operating Officer - Marketing and Distribution) took to the floor first up, a really interesting, knowledgeable man, who has been around the world several times comparing the world's public health and health insurance systems. I have broken down as best as I can his hour long presentation.

·         Southern Cross has 61% of the NZ market share.

·         Grew by only .08% last year.

·         Processing 2000 claims a day at $2.8 million.

·          Southern Cross has had an A+ Claim rate for 9 years in a row.

·         Southern Cross had 12% fewer cancellations last year.

·         They have the biggest Adviser Group and were happy to report that Group Schemes were on the rise.

However, on the negative side:

Unfortunately, NZ Health Insurance overall is in decline and has been for the past 3-4 years. This is a direct result of people’s disposable income being increasingly under pressure and the amount of redundancy increases. Also, confidence in Insurance Companies is at an all time low across the board.

Lack of disposable income among Kiwis is hurting the Health Insurance Industry.

Lars spoke with much passion and at great length about a significant problem we are having with specialists/surgeons overcharging and the perception from members and the public that the more the surgeons/specialists charge, the more it must mean they are “the best”. From the statistics, this is not entirely the case. Private practitioners have made sure they have greater demand than supply and have been able to apply this for a long time, by setting their price structure high, and this is not about to change in the foreseeable future. I guess what this means for Southern Cross and the Health Insurance industry is they are being effectively caught in the middle of paying too much and keeping up with meeting member expectations. This will take a long time to remedy, the surgeons and specialists are happy, very happy actually, and the members don’t care about cost as long as they can claim 100% of their procedure, Southern Cross unfortunately are left paying as necessary for procedures that are boosted in price by surgeons and private health care providers. You can understand Southern Cross’s frustration.

The cost being charged by private surgeons is doing damage to the health insurance business, according to Lars Bojsen-Moller.

A recent survey showed most Aucklanders refused to receive private treatment outside of Auckland. North Shore people refused to even receive treatment over the Harbour Bridge. Auckland is by far the most expensive city in NZ for any private procedure and that’s because quite simply, they just can be. For example:  A knee replacement would cost $17,990 in Marlborough and a whooping $26,029 for the exact same procedure in Auckland. The interesting fact is that if anything was to go wrong in Private Surgery/Hospital you end up in the Public hospital!

A lot of Auckland Private surgeons/specialist aren’t willing to contract with Southern Cross, they are price setting and getting away with it. However Southern Cross has contracts with some affiliated providers and this is when you swipe your card and the specialist involved sorts out your prior approval etc which has been the case for quite sometime and which they are hoping to spread further throughout the health care system. If this goes the way Southern Cross wants it to, they believe it will end up helping the public and make a positive impact on mitigating the stresses involved with health insurance prior approvals.

In the next part: We'll see what other initiatives and changes Southern Cross are looking at implementing, some statistics on claims, and how these changes will affect you as insurance clients.

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Visit the official Southern Cross website.

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