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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Health Insurance Top Claims 2013

In the past week, Southern Cross has released the statistics for the top five claim areas for men and women in each age band between 20 and 70.

Southern Cross Chief Executive Peter Tynan explains that the results show that people who are taking out health insurance need to check to ensure their policies cover what they need. Each age band was highly different in the type of surgeries or medical procedures that were most common, and knowing this information should inform your health insurance decisions.

Males between the ages of 20-30, whom Peter remarked often felt invincible and in our experience are the group that neglects health cover the most, nonetheless required claims most often for hernia repair, colonoscopy and excision of skin lesions. Women of the same age range claimed most often for freeing abdominal adhesions or ovarian cyst surgeries. These costly procedures required by people so young demonstrate the costs of being un-insured or underinsured, and we urge everyone to bear this in mind. I myself thank my lucky stars I got health insurance when I was young (or more accurately, my conscientious mother insisted on signing me up) because I've actually had to claim for a colonoscopy and a surgery, as well as many specialist visits after the age of 20 which I could never have foreseen.

It is also crucial that you think about medical insurance while you're healthy, as the presence of pre-existing conditions makes things very awkward, complicated and expensive, whilst it is clear sailing if you don't have any at the time of taking out your insurance.

Top 5 procedures, 20-29 age band

Women: Removal of teeth, endometriosis surgery, freeing abdominal adhesions, ovarian cystectomy, excision skin lesion.

Men: Removal of teeth, excision skin lesion, septoplasty, hernia repair, colonoscopy.

Top 5 procedures, 30-39

Women: Endometriosis surgery, hysterectomy, excision skin lesion, cholecystectomy, removal of teeth.

Men: Removal of teeth, colonoscopy, excision skin lesion, hernia repair, septoplasty.

Top 5 procedures, 40-49

Women: Hysterectomy, hysteroscopy, excision skin lesion, colonoscopy, endometriosis surgery.

Men: Colonoscopy, excision skin lesion, hip replacement, hernia repair, coronary angioplasty.

Top 5 procedures, 50-59

Women: Colonoscopy, hysterectomy, hip replacement, excision skin lesion, knee replacement.

Men: Hip replacement, colonoscopy, excision skin lesion, coronary angioplasty, hernia repair.

Top 5 procedures, 60-69

Women: Knee replacement, hip replacement, colonoscopy, cataract, excision skin lesion.

Men: Knee replacement, hip replacement, excision skin lesion, coronary angioplasty, colonoscopy.

Top 5 procedures, 70 plus

Women: Cataract, hip replacement, knee replacement, excision skin lesion, colonoscopy.

Men: Knee replacement, cataract, hip replacement, excision skin lesion, coronary angioplasty.

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