High claims top $6.8 billion

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Private health insurers paid a benefit exceeding $10,000 for over 332,00 claims in 2017 according to Private Healthcare Australia.

The association's annual high claims report, which includes data from all 37 private health funds, has revealed the total cost of all high claims increased by 5.9 per cent from the previous year to over $6.82 billion.

High claims represented 46 per cent of total benefits paid out on behalf of members for hospital treatment during 2017, said Private Healthcare Australia.

The highest benefit paid was $699,582 for the treatment of a patient with viral encephalitis. The patient was in the hospital for 163 days.

Over 11,000 episodes attracted benefits in excess of $50,000 while 750 had benefits of over $100,000.

The highest claim for cardiovascular disease was $575,195 for the treatment of heart valve disease. For cancer, the highest claim was $373,270 for the treatment of testicular cancer, while for mental health it was $134,547 for the treatment of bipolar disorder.

For health fund members aged under 30, there were 17,146 claims with benefits exceeding $10,000, an increase on the previous year of 1,000 claims. Of these, 1,949 claims were for neonatal care provided to premature babies with a total cost of $41.66 million.

Benefits for all high claims over $10,000 for people aged under 30 cost $321.8 million in 2017.

Private Healthcare Australia chief executive Dr Rachel David said the report highlights the value and contribution of private health insurance to people and Australia’s broader healthcare system.

“The report clearly shows private hospitals are now dealing with very complex cases like the public hospital system, and these are funded by private health insurance, taking the pressure off public hospitals," said Dr David.

“The report emphasises the importance of health fund membership for young Australians, with more than 17,000 high claims (benefits exceeding $10,000) paid for members under the age of 30 during 2017. This was an increase on the previous year of 1,000 claims (+6.2%).

“Many of these episodes involved hospital stays of more than 100 days for young Australians suffering from mental health issues, cancer and other conditions.

“More than 13.5 million Australians hold PHI and over half of those have disposable incomes under $50,000 per annum. More than 80% believe that they get value for money from their PHI. One of the main reasons for this is peace of mind as well as choice of doctor, choice of hospital, and timing of medical treatment,” added Dr David.