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$700,000: Australia’s most expensive health insurance claims

A composite image of an ambulance on a Sydney street and Australian money stacked on top of each other to represent the cost of health insurance claims.
Millions of Aussies made health insurance claims this year. (Source: Getty)

While private health insurance isn’t for everyone, some Aussies rely on it to help them when they need to cover particularly expensive medical bills.

Bupa, one of Australia's major health insurers, released new data showing what procedures Aussies were claiming the most and what were the most expensive.

Bupa said its most common claim of the year was gastrointestinal endoscopies, with more than 123,000 performed through hospital cover. Dental topped the list for extras, with more than 9.8 million claims.

Claims data from January to October provided an insight into the health and well-being needs of millions of Australians who made claims using their private health insurance this year.

The data for the year found Bupa’s most expensive benefit paid was more than $700,000 for a digestive condition, followed by $669,000 for a pregnancy-related hospital stay.

Hospital claims included more than 85,000 cancer treatments, including chemotherapy and radiotherapy, and almost 80,000 claims were made for dialysis for kidney failure.

More than 13,000 members underwent hip and knee replacements, with the average benefit paid at more than $24,000.

Those who went to hospital for heart-related procedures, such as valve replacements and coronary bypasses, had an average benefit paid of almost $9,000.

Dental was the most common extras service used, with one benefit reaching $3,800, while a member with ambulance cover in their extras received a benefit of more than $20,000 after requiring the Royal Flying Doctor Service in an emergency.

Bupa Health Insurance managing director Chris Carroll said Bupa paid about $3.9 billion in hospital cover and extras for its domestic customers between January and September this year.

“Our members have seen first-hand how important it is to have health insurance, with some members receiving paid benefits of more than $700,000,” Carroll said.

“This year, we’ve again seen how having health insurance offers peace of mind for those unexpected life moments and supports better preventative health and well-being, especially at a time when cost-of-living and inflationary pressures are impacting household budgets.”

Carroll encouraged members to make the most of their extras benefits before limits reset on January 1.

“This is a busy time of year, and we can sometimes push prioritising our health down the list,” he said.

“We want our members to make the most of their health insurance so now is the time to check your extras usage and squeeze in that massage, podiatry or acupuncture appointment, if you need to.”

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