HCF releases 2012 highest hospital claims data

Sydney, 7 March – Australia’s largest not-for-profit private health insurer, HCF, has today released data detailing the highest hospital benefit payments made to members during 2012.

In the 12-month period ending 31 December 2012, HCF funded more than 23,000 hospital admissions for which the benefit paid exceeded $10,000. Total hospital benefit payments for these high-cost admissions came to $467 million for the year.

Among notable claims handled by HCF:

• The highest individual claim paid for was $217,000 for a 68-year old member who fractured a knee and spent 100 days in a NSW private hospital;
• The highest combined claim paid for by HCF was $427,000 to treat premature twins, each of whom spent more than 90 days in a private hospital;
• Of HCF members aged 18-30 years, the highest individual claim was $76,000 for a 25- year old male in NSW who received spinal fusion in a private hospital;
• The highest payment for a public hospital was $131,000 for an episode of hospital care lasting more than 200 days;
• There were 130 benefit payments made by HCF that exceeded $50,000 in value, and for which the member was only in hospital for one day.

HCF’s chief medical officer, Dr Andrew Cottrill, said the data demonstrated the high costs associated with hospital care that can hit Australians of any age.

“Our figures show that hospital care can get very costly, very quickly regardless of age. Private health insurance cover protects people in the unfortunate event of injury or illness, and helps ensure they can access high-quality hospital care promptly.”

HCF consistently performs strongly on key industry measures of member value. In 2012, the fund returned 91 cents in the dollar of premium contributions to members in the form of benefits, well above the industry average of 85 cents.