 My colleague Steve required a minor operation part-way through 2007, and was pleasantly surprised at his dealings with his New Zealand health insurance company, despite the fact that he had only had his policy for a short time before claiming on it. Please read on for his account:
I'm aware from my dealings with clients that some are wary of taking out insurances (be it in New Zealand or any other country in the world) as they think that the insurance companies will do anything they can to avoid having to pay out.
Having worked in the past for insurance companies I have seen the background to cases that have subsequently been in the press as non-payment complaints – 99% of the time they are due to non-disclosure of relevant medical information by the claimant when they set up the plan. This of course never appears in the press article, which subsequently is very one sided. I thought therefore that you may find my experience as a health insurance claimant of interest, as it shows the other side of my industry. By the time you read this I will probably be at home with my feet up for a week or so as I am just about to have some surgery carried out (nothing serious I’m pleased to say). I do put my money where my mouth is and do have my own Health Insurance cover in NZ. It is with one of the two companies we particularly like for this type of cover and to whom we recommend our clients. I would therefore like to share with you my personal experience of getting claims paid.  As our Health Insurance was the last protection policy I arranged for my family, we had only been paying premiums since November. Around a month ago I had to have an ultrasound test carried out so contacted my provider with I have to admit a little apprehension due to the short period I had been paying premiums. I approached them as a client and didn’t highlight to the claims team that I am an adviser.
Within half an hour I had received a fax to complete to apply for prior approval of payment of costs. This compared to what would have probably taken a week to receive in the UK! I completed the form and sent it back to them and within a couple of days had received a letter confirming that my costs would be met in full.
The result of an ultrasound showed that I needed surgery and that the cost of this would be approximately $5,000. I must admit that as we have only paid in around $400 in premiums since the plan started, I did feel a bit guilty but also mightily relieved! As my first claim had only been for the ultrasound costs I therefore had to separately apply for approval for the operation costs and again this was approved amazingly quickly and so I go into hospital in a couple of days knowing costs are covered. I have $300 excess on my policy but this did not apply to tests and consultant visits. So in summary everything will have been completed within two months rather than the two years plus that it could have taken on the health service, and all in private hospitals. And the icing on the cake, everything is billed direct to the insurance company so I don’t even have to pay and claim it back. I hope this does highlight that claims do indeed get paid when justified and genuine.
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