Southern Cross has revealed that spinal fusions was the most expensive surgical claim in the year to 30 June 2021, with the most expensive claim costing $222,000. Radical neck dissection surgeries were the next most expensive claims. The three most common claims made were for cryotherapy procedures (34,000 claims), excisions of skin lesions (31,000 claims) and minor surgery performed by a GP (26,000 claims). In the year ended 30 June 2021, Southern Cross paid more than three million claims valued at $1.12 billion.

“Surgery for bad backs has topped the list of most expensive surgical claims funded by Southern Cross Health Insurance (Southern Cross) in the year to 30 June 2021, with the highest individual claim coming to $222,000.

Eight of the top 10 most expensive claims paid by New Zealand’s leading health insurer were for spinal fusions - surgery which permanently connects two or more vertebrae in the spine – with four claims topping a whopping $200,000.

Southern Cross Chief Medical Officer, Stephen Child, said that the expense and volume of these claims demonstrate the value and benefits of health insurance.

“Whether you require expensive surgery such as spinal fusion, or if you are one of thousands needing a more common procedure, such as the removal of a skin lesion, Southern Cross members can have the assurance they are covered for unexpected events.”

The next two most expensive claims were for radical neck dissection surgery, which involves the removal of cancerous tumours, with each claim totalling more than $150,000.

Child said spinal fusion is a highly complex procedure and therefore can be very costly.

“Spinal fusion surgery is a very serious procedure that’s typically performed by an orthopaedic surgeon or a neurosurgeon. Often it involves the implantation of extensive metalware and artificial bone, which results in additional cost and expense.”

Southern Cross is a not-for-profit Friendly Society which operates solely for the benefit of members. For the year ended 30 June 2021, it paid more than three million claims valued at $1.12 billion

When looking at what were the most common claims paid by Southern Cross, the highest by volume was cryotherapy procedures (34,000 individual claims), followed by excisions of skin lesions (31,000) and minor surgery performed by a GP (26,000).

Cryotherapy breaks down skin lesions or skin abnormalities at the site through freezing. A skin excision procedure involves the cutting of abnormal tissue away from healthy tissue.

Colonoscopies, which look for signs of bowel cancer and investigate causes of pain, bleeding or changed bowel habits, were the fourth most commonly-funded procedure, with 23,000 claims paid by Southern Cross.

“Given the high incidence of skin cancer in New Zealand, it isn’t surprising skin lesion removal is one of the most common procedures we fund,” Child said.

Although the individual claim costs can be high, Southern Cross Health Society’s Affiliated Provider programme has helped to dampen rising healthcare costs, achieving more than $220 million of savings for members through the programme since 2012.”

Top 10 most expensive individual claims in FY21

Procedure	Total paid
Spinal Fusion	$222,000
Spinal Fusion	$210,000
Spinal Fusion	$201,000
Spinal Fusion	$200,000
Spinal Fusion	$179,000
Spinal fusion	$175,000
Radical Neck Dissection	$170,000
Radical Neck Dissection	$156,000
Spinal Fusion	$156,000
Spinal Fusion	$153,000

Top 10 procedures by volume in FY21

Procedure	Description	Number of procedures funded
Cryotherapy of Skin Lesions	Liquid nitrogen treatment to freeze and destruct an abnormality.	34,000
Excision Skin Lesion	Cutting out abnormal tissue away, usually related to cancer.	31,000
GP minor surgery	N/A	26,000
Colonoscopy	An exam used to detect changes or abnormalities in the large intestine (colon) and rectum.	23,000
Intravitreal injection	An injection or shot of medicine into the eye.	10,000
Nasendoscopy	A test to look at the inside of the nose, the throat (pharynx) and the voice box (larynx).	9,000
Biopsy of Skin and Subcutaneous Tissue	A procedure to remove cells or skin samples from the body for laboratory examination.	9,000
Cataract extraction and insert IOL	Removal of cloudy lens in the eye and replacement with artificial IOL (intraocular) lens.	8,000
Gastroscopy (+/- Biopsy / Polyp)	A procedure to examine the upper part of the digestive system.	7,000
Removal of Teeth	N/A	6,000

In other news

Cigna: Gabe Smith new chief architect

Cigna: David Marquis to become head of data

Southern Cross offers a multitude of direct and adviser products. On Quotemonster we currently only offer the following products, however are looking to include more in future:

• Wellbeing 1 (WB1)
• Wellbeing 2 (by choosing WB1 and selecting Specialists and Tests as included we move to Wellbeing 2)
• Wellbeing (either 1 or 2) + Chemotherapy 100
• Wellbeing (either 1 or 2) + Chemotherapy 300

In order to include the Cancer Cover Plus upgrades - Chemo 100 and Chemo 300, you can do so by selecting the product in your "Settings" screen (as per our screenshot below)

If you wish to compare some of the benefits within a Southern Cross product, here is a Plan Comparison Chart that provides a general idea.

Happy Crunching!

Fidelity Life has announced the approach they are taking for managing new business and underwriting processes for medical examinations, tests, and occupational and financial underwriting requirements under different alert levels. Below are the different approaches.

In other news

September 10 is World Suicide Prevention Day

Fidelity Life: no current policies have an exclusion for Covid-19 or the effects of the Covid-19 vaccine. Customers are fully covered according to their policy’s terms and conditions.

Southern Cross: Chris White set to be new CEO after Terry Moore retires on 1 October 2021

From Good returns: Insurance industry complaints on the rise

We hear a lot about how hard covid-19 control measures - especially those that restrict people to just home, or 'lockdowns' - are on mental health. Clearly, for some people, they are catastrophic: someone in a deteriorating relationship with a violent partner would clearly be devastated by a  stay-at-home order. While we have had some interim announcements on the subject here, which were reassuring, we haven't had much data to go on, until now. A recent study on suicide rates in England and Wales during the beginning of the COVID-19 pandemic helps to fill that gap.

The study was based on official death registrations from April to July 2020. It was found that there were fewer suicides than the previous year with 1,603 suicides on record, compared to 1,955 suicides in 2019. The study found the 2020 suicide rates were lower than the 5-year average (2015 to 2019 April to July period)  of 1,835 suicides. The study also revealed that men made up 73.9% of the recorded 1,603 suicide deaths between April and July 2020. The study has credited the lower suicide rate between April and July 2020 to a reduction in suicide during April 2020. That is encouraging news, it means we cannot automatically assume that stay-at-home orders will result in more suicides. On the other hand the UK plainly has a much better track record in dealing with mental health challenges that we have (compare suicide rates per 100,000 of population for evidence). Click here to read more

In other news

Lifetime: Lifetime Group set to acquire One50 Group

Southern Cross: Talking about dad's health on Father's Day

FSC Connect: Customers, complaints, code and claims - What have we learnt from COVID-19?

In conjunction with The Ethics Conversation, Financial Advice NZ is offering an ethics course that will be delivered by Jane Arnott, Director of The Ethics Conversation. The three-hour online workshop is designed to support financial advisers looking to demonstrate their commitment to professional ethics. The workshop will be based on three modules and will refer to the Code of Professional Conduct for Financial Advice Providers and Financial Advisers. Various topics will be covered including:

• business ethics fundamentals
• conflicts of interest
• bias and speaking up
• an examination of risks, challenges and ethical dilemmas
• potential for dilemmas
• role of the professional
• difference between compliance and ethics

Cost:

For members: $200 +GST

For non-members: $300 +GST

“This workshop delivered by Financial Advice NZ & The Ethics Conversation supports and enhances the competence of financial advisers seeking to demonstrate their commitment to professional ethics and good practice that underpins all client relationships.

The workshop session covers: business ethics fundamentals, conflicts of interest, bias and speaking up, along with an examination of risks, challenges and ethical dilemmas. It refers to the Code of Professional Conduct for Financial Advice Providers and financial advisers. It examines the potential for dilemmas to arise and reflects on the role of the professional and provides conceptual clarity around the difference between compliance and ethics.”

In other news

RBNZ: Reserve Bank welcomes High Court decision penalising TSB Bank for AML/CFT Act breaches

Financial Advice: Let's talk lending: Panel discussion with the experts

Southern Cross Pet Insurance: top five cat and dog claims paid for the period 1 June 2020 – 31 July 2021

If you’ve noticed that an insurer tends to drop off when you’re quoting a package that includes medical cover, then we’d like to share a tip with you!

One of the most important features on Quotemonster is your “Settings” screen – as well as being able to set up your default occupation codes, Research report settings (whether you prefer our standard or star ratings, benefit overview or heatmap reports), user settings and security, the settings is where you can select your default product basket.

We highly recommend selecting your basket when you first create a Quotemonster account however you can alter this at any time.

Some of the major insurers like Fidelity, Cigna or Asteron do not offer a health insurance product so you can link them to a health provider which will them allow them to show up in your quotes.

Happy Crunching!

The following health insurers were included in the FMA's Insurance Conduct and Culture: Fire and General Insurers Update:

• Accuro (HSWS)
• nib
• Police Health Plan
• Southern Cross
• Unimed

The following life insurers were included in the report: 

• DPL Insurance Limited (which offers both fire and general and life insurance)
• Booster Assurance Limited

Given the report is on conduct and culture the issues are not fundamentally different whether the cover offered is life, general, or health. However, it is worth pointing out in case you were unaware of the inclusion. 

Medical Pricing Database version 87 has now been issued to all subscribers. This version includes the following changes:

nib and Southern Cross price changes both effective 1 July 21.

Asteron Life is holding webinars on 27 May at 2pm and 3 June at 9.30am. The webinars will be focused on Trauma Benefits. Today’s webinar will be run by Kirsten Young and next week’s webinar will be run by Crush Huston. During the webinar, both Kristen and Crush will go through how each benefit work individually and when combined. Advisers that want to attend are encouraged to contact the Asteron Life Business Development team.

“I would like to extend an invitation to you for our upcoming webinar on Trauma Benefits. This webinar will cover:

• Trauma Recovery
• Continuous Trauma
• Major Trauma
• Early Stage Cancer
• Early Stage Trauma
• Cancer Cover
• Kids Cover

Join Crush Huston or Kirsten Young as they showcase how each of these benefits work on their own, as well as together. To attend one of our two sessions, please find the date and time below which works best for you, then click the link to add the invite to your calendar.”

In other news

Cigna: Nicolette Luke finalists for the MAS - Medical Assurance Society Young In-house Lawyer of the Year Award 2021

Southern Cross:  Account Manager – SME

From Insurance Business Mag: Are insurers vulnerable to cyberattacks?

AIA: Group Pricing Specialist role advertised

Asteron Life: Northern Busines Development Manager role advertised

Introduction

The rising costs of specialist imaging and medical tests really shows the importance of having medical coverage in the world we live in today. 

An adviser recently informed us of a significant feature two insurers have included in their Diagnostic Tests benefit. Partners Life will apply a $250 standard excess for these claims, regardless of if the selected excess is $250 or above. Furthermore, in a policy year, the excess will only be deducted once at the first claim, then no additional excess will be applied in that period. In contrast, Southern Cross does not apply any excess for their Diagnostic Imaging or Tests, however, these will need to be performed by an affiliated provider.

To reflect this in our Research ratings we have added the following sub-item:

                “Diagnostics excess is not limited but matches plan excess” 

To clarify, the providers that will apply the selected excess for a Diagnostics Tests claim will have a deduction for this sub-item, while those that offer a lower or nil excess will not.

Sub-items rating

Why is this important?

This is an example of a significant difference that we are able to capture in our Definition scoring. While a lowly weighted item, it surely is important to those customers that have selected high excesses and would not be eligible for a Diagnostic Tests claim with some insurers when the claim level is lower.

Your feedback

We value getting your feedback on how these wordings are being applied to claims you may be aware of. Please email us with details of any recent claims to help us update our understanding.

Doreen Dutt, Research Analyst, Quality Product Research Limited, researcher@qpresearch.co.nz