How is a health insurance claim assessed?
Find out how your claim is assessed and what’s involved
We know for many of our members, going to hospital can be a daunting experience. From finding out you need to have a procedure, to booking it in and working out how much it will cost, there’s a lot to consider.
Top of your list should be choosing the right specialist. It’s important to remember that you have control over which specialist you visit. Not only can choosing the right practitioner save you time and money, but it also means you have the power when it comes to your health and subsequent surgery.
But what if you find the right specialist at the wrong price?
At nib, we want you to focus on your health, not worry about your health insurance. That’s why we’ve launched a new initiative called nib Clinical Partners.
It’s our network of some of Newcastle and Lake Macquarie’s experienced orthopaedic surgeons, who have committed to performing hip and knee joint replacement surgery with no out of pocket expenses.
Providing your health cover includes joint replacement surgery, and you’ve served any necessary waiting periods, we’ll cover the full cost of your hospital procedure. So, you’ll have nothing but your hospital excess to pay toward the cost of your total hip or knee replacement.
This is just one of many ways we’re helping to improve affordability and information transparency for our members.
Your surgeon can determine their fees on a case-by-case basis and for a number of reasons, including their geographic location, reputation or individual patient circumstances – they can essentially charge what they believe their service is worth.
Our Clinical Partners program means participating specialists have committed to charging no out of pocket expenses for nib members, no matter the circumstances of your hip or knee replacement. To date more than 100 members have participated in the program saving almost $1,000 in out of pocket costs per procedure.
For nib member Ian, who recently underwent a bilateral knee replacement, this was one of the most valuable parts of the program.
“It was a wonderful load off my mind not to worry about expenses when there are so many other things to think about,” he says.
You shouldn’t see any bills for your procedure, but if you do, get in touch with your nib Health Concierge and they can help.
Another benefit of the program is that if your surgeon thinks you’re a suitable candidate, you may be able to recover from surgery in the comfort of your own home with a physiotherapist coming to you.
A recent Australian study suggests that patients who go home after knee reconstruction surgery do just as well as those who stay in hospital. And, with at home recovery meaning you have access to your own fridge, bathroom and wifi (#priorities), it’s well worth considering.
This program can help you:
“The program offers opportunities for people to gain a quick recovery in the comfort of their own home with dedicated professional staff who are able to offer expert advice,” Ian says.
“The physiotherapist was a great motivator and was looking for results and adjusting where necessary to keep progress moving. The advice was excellent and relevant to each stage of my rehab.”
Through the Clinical Partners program, you’ll also be supported by a dedicated nib Health Concierge, who’ll ensure you’re prepared for surgery, will help set up for your recovery and call to check in on your progress after you’ve returned home from hospital.
“Having a familiar person attuned to your stage of the process is vital,” Ian says.
“All nib staff involved with my case were excellent. I could not fault their dedication to my quick recovery for which I am so very grateful.”
To check you’re covered and learn more, contact us about nib Clinical Partners program on 1800 339 219 (9am to 5pm Monday to Friday) or [email protected]