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Medibank: 10 biggest hospital benefits claims

Peter Terlato 25 January 2017

health insurance claim form hospital medical

Substantial increases in admissions and benefits paid.

Neonatal health care dominated the top ten highest paid national hospital benefits claims, according to private health insurer Medibank's latest expenditure report.

Medibank's Health Cost and Utilisation Report 2016 reveals 6 of the top 10 largest payouts were for neonatal care, with the highest single claim exceeding $430,000 for a NSW beneficiary.

Neonatal care refers to newborn infants or the first 28 days of a child's life.

The four other procedures that warranted significant claims were all tracheostomies, of which the highest amount paid ($339,273) was claimed by a 62-year-old Queensland member.

A tracheostomy is where a surgical incision is made to the windpipe to relieve breathing obstructions.

Top 10 Medibank hospital claims 2016
ProcedurePatient ageMembership stateBenefits paid for single claim
Neonatal0NSW$430,599
Neonatal0QLD$366,591
Neonatal0QLD$364,864
Neonatal0QLD$345,273
Tracheostomy62QLD$339,273
Tracheostomy79NSW$318,608
Neonatal0QLD$293,659
Neonatal0QLD$284,377
Tracheostomy80QLD$274,423
Tracheostomy80SA$270,219

The report also identified sizable increases in admissions and benefits paid to Medibank customers, particularly in the areas of childbirth, rehabilitation and joint surgeries.

Despite admissions falling 16% over the last four years, childbirths (19,472 in 2016) remain the most common overnight procedures in terms of hospital claims.

Rehab and knee replacement admissions increased 15% and 11% respectively between 2013 and 2016.

Five most common overnight procedures
ProcedureNo. hospital admissions (2016)Admissions (2013-2016)Average total cost (2016)
Childbirth19,472-14%$9,421
Rehab17,17515%$11,015
Knee replacement8,16111%$24,127
Shoulder procedures6,281-5%$10,176
Hip replacement5,6954%$27,702

The five most common same-day services were colonoscopies, chemotherapy, dialysis, rehab and cataract procedures. Since 2013, chemo admissions have risen 8% and cataract procedures are up 7%.

Last week we reported the number of Australians dying from blood cancer is now double those losing their lives to melanoma skin cancer, according to the latest medical analysis research.

Trying to decide which hospital option is better for you? It's sensible to compare public and private cover, consider wait times and safety and understand how to claim health insurance when visiting.

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