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nib partners with surgeons to guarantee no out-of-pockets for members

Child looking at parent recovering from an injury

nib said it's tackling head-on members' frustration with one of their biggest pain points with their private health insurance by partnering with orthopaedic surgeons to guarantee no-out of-pocket costs. Members are also being provided with increased treatment choice. So for example, access to post surgery rehabilitation at home when the doctor considers it clinically appropriate.

Initially launched in the Hunter region, nib's Clinical Partners program involves select Orthopaedic surgeons and their entire surgical team who have committed to performing hip and knee joint replacement surgery for nib members with no out-of-pocket expenses above their hospital excess.

With consent from the surgeon, nib members can also choose to recover from the comfort of their home with visits from a dedicated physiotherapist as well as the inclusion of a rehabilitation plan and personalised support from a nib program coordinator.

nib Managing Director, Mark Fitzgibbon said the partnership reflects nib's ongoing commitment to improving the member experience and reducing the uncertainty around surgery costs that members too often experience.

"We know affordability and out-of-pocket costs are without a doubt the two major pain points for our members. Unexpected costs are a major reason why members drop or downgrade their private health cover and the discrepancy in costs for the same surgery can differ by thousands of dollars," Mr Fitzgibbon said.

"In addition, recent studies suggest patients who go home after a knee replacement surgery do just as well as those who stay in hospital. Through our Clinical Partners program, we're able to provide our members end-to-end protection, meaning all they need to do is focus on what’s most important, their better health," he added.

John, a retiree from Swansea (NSW) was one of over 100 members who have since completed the program after undergoing half-knee surgery on his right leg. After surgery John received at-home rehabilitation through nib's partnership with Newcastle physiotherapy and allied health clinic, Ethos Health.

"My at-home rehabilitation was most beneficial because I wasn't able to drive for six weeks after surgery and my partner lives and works in Sydney, so I was unable to get out of the house to go anywhere.

"Over three weeks, I had about five or six physiotherapy appointments at home and now I'm continuing the sessions at the Ethos Health clinic. It was seriously the best thing for me post-surgery," John said.

John was supported throughout the entire surgery process by a dedicated nib coordinator who ensured any questions or concerns were met and the in-hospital and at-home treatment ran smoothly.

"It was great, I had no worries at all about the surgery as the coordination was all wonderfully done. I cannot fault the whole system and I've already mentioned it to other people how good the program has been. I'm also on a pension now, so not having any out-of-pocket costs and my health insurer covering everything is certainly a big benefit," John added.

To date, over 280 members have either enrolled, are undergoing or have completed surgery as part of the program. nib is looking to expand the program to include additional surgical disciplines and locations across Australia. Based on nib claims data for calendar year 2018, medical specialist fees for hip replacements ranged from $1,318 to $10,000. In some cases, this meant members had an out of pocket cost of almost $8,700.