Now we are getting into an area where the unexpected costs can get reasonably expensive quickly. Choosing to insure, rather than paying your way, becomes a more realistic decision. With a specialist consult often costing $400, this starts hurting your pocket right from the start.

Unlike the two previous areas, GP's and Dental & Optical, where you drive the activity and the subsequent claims. Which tend to be lower in value but result in higher costs to the insurer and premiums for you. Specialists & Diagnostic Testing is driven directly by your health, and surprisingly is often cheaper to insure for than the either of the previous two sections. (Preventative medicine is excluded)

Because this is a step up from primary care, there is less claim activity from an individual, but the claims do tend to be larger. With most policies giving you at least $4,000 per person per year for specialists & testing, there is usually more than enough to cover what is required. If it is more serious, then the major diagnostics benefits under the hospitalisation plan starts to come into play, for things like MRI and Cat scans.

We find a typical specialist claim, with some testing but without hospitalisation, will be between $250 and $1,500. If it progresses to surgery then there is often about another $1,000 spent in this area.

Specialists & Diagnostic Testing enables you to access treatment and testing without the barriers of out of pocket costs and waiting for the public system. Most medical treatment providers will want you to settle accounts as you incur costs, pre-approval and direct payment by the insurer is possible if you need it. If you are talking to us about your claim early, and things are organised, we often see claims you have paid directly in this area, reimbursed into your account in 48-72 hours. With the banking system begin about 24 hours of that, depending on which bank you bank with.

Something to keep in mind, things like X-Rays and tests requested by your GP are able to be covered here, as are the short falls when you're dealing with ACC related testing. The majority of medical policies top up what ACC covers, so your out of pocket costs with ACC are often claimable too.

It pays to have a chat with us when you are facing a health situation, as sometimes what you interpret as an exclusion on the policy, in certain situations may not be excluded. This is because the secondary use for a particular treatment may be claimable, if it's medically necessary.

A good example of this is a contraceptive device, which for contraception is excluded on all policies. However in certain situations this device is a better alternative treatment than surgery for a condition. Both because it is less costly, but it is less risky than the surgical alternative. Not to mention less invasive, less recovery time and if income protection is involved not claimable, as there wouldn't be any time off work either. So makes a lot of sense for the insurance company to pay in this sort of situation.

Specialists & Diagnostic Testing is the one area of medical insurance that does deliver a lot of value to policy holders. Most policy holders will have a number of claims in this area before they have to claim for hospitalisation. Often this is for minor conditions and investigations to rule out serious conditions quickly, which reduces stress and provides piece of mind. This also means you are getting the right treatment quickly.

Next - Hospitalisation, surgical & non-surgical

Physical Address:
5i Miro Place

Phone: 09 973 2849

Postal Address:
PO Box 301792