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Bad Backs The Cause Of Most Expensive Health Insurance Claims

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.

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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

ProcedureTotal 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 
ProcedureDescriptionNumber of procedures funded
Cryotherapy of Skin LesionsLiquid nitrogen treatment to freeze and destruct an abnormality.34,000
Excision Skin LesionCutting out abnormal tissue away, usually related to cancer.31,000
GP minor surgeryN/A26,000
ColonoscopyAn exam used to detect changes or abnormalities in the large intestine (colon) and rectum.23,000
Intravitreal injectionAn injection or shot of medicine into the eye.10,000
NasendoscopyA test to look at the inside of the nose, the throat (pharynx) and the voice box (larynx).9,000
Biopsy of Skin and Subcutaneous TissueA procedure to remove cells or skin samples from the body for laboratory examination.9,000
Cataract extraction and insert IOLRemoval 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 TeethN/A6,000

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