Giant health insurer Southern Cross has released a list of its biggest claims, with three topping the $100,000 limit on many of its policies.
The rising cost of medical equipment and treatment has been driving the cost of claims up for health insurers, resulting in big premium rises year after year for policyholders.
The figures released today by Southern Cross Health Society indicate where the greatest funding pressures are for health insurers.
Cancer, heart disease and spinal conditions triggered the highest health insurance claims paid out by Southern Cross last year.
The three largest claims were for spinal surgeries and a larynx removal respectively, claims in which the not-for-profit insurer paid at $160,000, $151,000 and $100,000.
A further five claim payouts ranged from $91,000 to $98,000, and had there been no cover, the policyholders who got treatment would have had to foot the bill themselves or rely on the state health system, probably experiencing a wait before treatment.
Peter Tynan, Southern Cross Health Society chief executive, said the size of the claims demonstrated the value of insurance, and those who were paying most for it - the elderly - were the biggest recipients of the big payouts.
Those receiving the 10-highest claim payments were aged from 64 to 76 years, but he warned that insurers excluded existing conditions so people needed to think hard about a decision not to take out health insurance when they were younger.
"These figures also highlight the cost of medical procedures - how expensive elective surgery can be," Tynan said.
"Those wanting to go private need to think about how they'll fund it.
"If they choose to self-insure, people should have realistic expectations of what they'll need."
A knee replacement cost between $19,000 and $24,000, cardiac bypass surgery between $43,000 and $50,000 and one course of radiation therapy between $15,000 and $27,000, he said.
Younger policyholders did make claims too, and Southern Cross released details of the top-three claims areas for different age brackets.
Under 20s
- The biggest claims area was tonsillectomy ($4.52m paid) followed by the removal of teeth ($4.06m), and grommet insertion ($1.89m).
Age 20-29
- Removal of teeth ($4.77m), endometriosis surgery ($1.75m), and medical consultation ($921,000).
Age 30-39
- Endometriosis surgery ($2.45m), removal of teeth ($2.03m), and hysterectomy ($2.02m).
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