Medibank: 10 biggest hospital benefits claims

Peter Terlato 25 January 2017 NEWS

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
Procedure Patient age Membership state Benefits paid for single claim
Neonatal 0 NSW $430,599
Neonatal 0 QLD $366,591
Neonatal 0 QLD $364,864
Neonatal 0 QLD $345,273
Tracheostomy 62 QLD $339,273
Tracheostomy 79 NSW $318,608
Neonatal 0 QLD $293,659
Neonatal 0 QLD $284,377
Tracheostomy 80 QLD $274,423
Tracheostomy 80 SA $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
Procedure No. hospital admissions (2016) Admissions (2013-2016) Average total cost (2016)
Childbirth 19,472 -14% $9,421
Rehab 17,175 15% $11,015
Knee replacement 8,161 11% $24,127
Shoulder procedures 6,281 -5% $10,176
Hip replacement 5,695 4% $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.

Latest health insurance headlines

Picture: Shutterstock

You might like these...

Ask an Expert

You are about to post a question on finder.com.au:

  • Do not enter personal information (eg. surname, phone number, bank details) as your question will be made public
  • finder.com.au is a financial comparison and information service, not a bank or product provider
  • We cannot provide you with personal advice or recommendations
  • Your answer might already be waiting – check previous questions below to see if yours has already been asked

Finder only provides general advice and factual information, so consider your own circumstances, or seek advice before you decide to act on our content. By submitting a question, you're accepting our Privacy & Cookies Policy and Terms of Use, Disclaimer & Privacy Policy.
Ask a question
Go to site