What’s the biggest health claim paid for a procedure?

The health insurance industry has been experiencing a time of rising medical costs, where both volume of claims and inflation have been increasing. We’ve taken a closer look at individual claims values that a few insurers have released recently. As you can see from the data below, the costs of individual claims can be astronomical.

nib regularly publish their top 5 health claims by month. RiskinfoNZ has an article collating historical nib’s top health claims by month here.

nib’s top health claims for January 2025

Treatment                     Cost              Gender              Age

Spinal surgery               $101,000         Male                   16

Cardiac surgery           $85,000           Male                   46

Cardiac surgery           $56,000           Male                   70

Cardiac surgery           $54,000           Female               70

Digestive surgery          $53,000          Male                   72

nib’s top health claims for December 2024

Treatment                      Cost                Gender               Age

Cardiac surgery            $103,000          Male                   72

Cancer surgery             $102,000          Male                   77

Cardiac surgery            $93,000            Male                   80

Cardiac surgery            $88,000            Male                   76

Spinal surgery                $87,000            Male                   48

But these do not top the charts of what we are currently aware. Southern Cross’s most expensive surgical claims were $256,165 for a spinal fusion procedure and $127,191 for a breast reconstruction.

While Partners Life don’t release a similar monthly overview of their top claims, their ‘The story behind our claims’ slideshow highlights their largest single payouts since 2011. The most expensive claims paid out were a whopping $1.6 million+ for Total and Permanent Disability or Income cover; $2.9million +for Life cover; $3.2million + for Trauma cover and $982,000+ for Private Medical Cover.

While the majority of claims won’t cost anywhere near as much, what used to be ample caps of some older medical values don’t seem so rosy in light of recent inflation and surging claims costs. Yet we haven’t seen any insurers coming out and indexing claims caps. We think that’s wrong, and we’ll offer a score boost to the first insurer who offers indexed caps.

What types of claims have you heard of and how did they go? We would love to hear more from you, especially if you are a Quotemonster subscriber, through our adviser claims experience tool (check the side menu when you are next logged in).

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