Health Insurance - My Southern Cross policy has 80% cover meaning I pay 20% My question is that SX have a approved set

Hi
I am a New Zealand lawyer based in Wellington and will help you with your question today. Please give me a minute to read the question

This will depend on the contract with Southern Cross and on their contract with the private hospital. The private hospital of course bills Southern Cross, and I assume you would need to either pay the 20% balance to Southern Cross or the private hospital. It would be determined on the terms of the insurance cover, as to whether they can charge for the actual time that you spend at the private hospital or whether they are entitled to charge the approved set fee. If the terms of the contract are not sufficiently clear, you could tell them you will just pay for the time actually at the private hospital and no more. The situation really hinges on the terms of the contracts however

It is the insurance company who set the rules and often to their own advantage rather than to yours. The only other alternative would be to make a formal complaint about the fee if you are not going to use the time at the hospital, which you could make to the Insurance and Savings Ombudsman. But certainly discuss it with the hospital and the insurer to see if they will adjust given that you have to pay 20%

I think you should tell them before the surgery that you are concerned that you only pay for the time you spend in the hospital. Then they will be on notice that there is an issue if you leave a lot earlier