Tardy insurer galls patients

By ELEANOR BLACK

Extra staff and polite letters of apology are doing little to satisfy frustrated Southern Cross Healthcare members waiting for payouts.

Fed-up policyholders contacted the Herald yesterday to say they were sick of waiting for the country's largest health insurance provider to pay for their medical and surgical procedures.

They were equally tired of listening to hold music when they phoned the insurer's call centre.

Southern Cross spokesman Dr Michael Ashby said it was paying out $1 million in claims each day and expected the seven-week turnaround would be down to three weeks by the end of this month.

The company is blaming the payment backlog on a three-month switch to a new computer system that was completed last month.

But people who put in claims at the beginning of November say they are still waiting for payouts and are receiving bills from doctors who say they cannot afford to wait for the insurer to pay up.

On Wednesday, the executive director of the Private Hospitals Association, Lesley Clarke, said private surgical hospitals were owed $26 million and some were under financial pressure.

Dr Ashby said yesterday that private hospitals were owed between $4 million and $5 million, compared to the usual $2.5 million to $3.5 million.

Auckland woman Julie Spillett is owed $795 for medical procedures and doctor's visits.

A claim lodged on November 10 has still not been paid, despite assurances from Southern Cross yesterday that they were processing claims made on November 29.

Mrs Spillett, a member for 25 years, said she normally received payment within five working days.

"I think it's disgusting," she said. "I ring and ring and ring. If they're up to November 29, where's my money?"

Barney Starcevic, also of Auckland, is so irritated by the eight-week delay in payment for a $170 specialist's visit that he will withhold premium payments until the problem is fixed.

"They say they're sorry they can't pay you, but they're sending an invoice asking you for money."

He twice called and left messages at the company's call centre but never received a reply.

Dr Ashby said a second call centre had been set up to deal with the overflow. People lodging claims yesterday could expect to receive payment in about four weeks.

He was "reasonably confident" that by the end of the month the waiting period would have returned to three weeks, due to extra staff and longer working hours.

Fewer claims over the holiday period had helped ease the backlog but the insurer was now receiving an average 2000 claims each day.

When the Herald phoned the Southern Cross call centre yesterday, waiting times varied.

A call placed at 11.16 am was answered after 10 minutes 44 seconds. At 2.22 pm, it was 4m 48s before a human voice was heard and at 4.55 pm it took 6m 21s.

* If you are a Southern Cross member having trouble with a claim, please send an e-mail to
newsdesk@nzherald.co.nz