Southern Cross updates policies

Health insurer Southern Cross has made changes to its policies and tweaked it affiliated provider programme.

Thursday, May 25th 2017, 3:09PM

Head of member services Anthony McPhail said there would be new cover added for 13 technologies, including transoral robotic surgery (TORS), endoscopic ultrasound, digital breast tomosynthesis (DBT) and transcatheter aortic valve implantation/replacement (TAVI).

“We know that advances in medical technology can significantly improve health outcomes for our members. Our health service providers regularly submit procedures for us to prioritise and assess. Once we’ve done that, and confirmed the technology can improve patient outcomes at an acceptable cost, we can proceed with introducing cover.”

He said the expansion of Southern Cross Health Society’s Affiliated Provider Programme from July would also bring benefits for the Society’s 830,000 members.

Affiliated Providers are doctors, specialists and facilities that work with Southern Cross Health Society to provide services at agreed prices.

Southern Cross head of provider networks Rebecca Ogilvie said the programme helped the society keep rising healthcare costs in check.

“The positive impact on our members’ experience is significant,” she said.

“There’s no need for them to pay upfront or fill out claim forms and wait for reimbursement at what can be a stressful time.”

The programme has been in place since 1997 and its expansion will see specialist consultations and imaging, such as x-rays and ultrasounds, become Affiliated Provider-only healthcare services.

Last financial year the programme delivered more than $370 million in healthcare services which members didn’t have to pay upfront for. It is also estimated that it moderated rising healthcare costs for members by around $6.6 million.

About 60 per cent of all Southern Cross claims costs come through Affiliated Providers and, nationally, the Society has 1100 Affiliated Provider agreements with around 1600 practitioners working across 20 specialties.

Tags: Southern Cross