There are two ways that you can claim for your procedure and/or medical treatment.

If you haven’t already had the procedure or treatment, and it falls into one of the below categories, then you will need to apply for pre-approval before you have the procedure or treatment.

  • Is the procedure or treatment likely to cost $1,000 or more?
  • Is the procedure or treatment likely to require hospitalisation?
  • Would you just like to make sure that the procedure or treatment is covered under your policy?

If the procedure and/or medical treatment has already taken place, then you will need to submit a claim.

Pre-approval and why you may need to apply for it

Before you have a procedure or treatment, check to see if your insurance policy covers the procedure or treatment you need.

Pre-approval is when we give you confirmation of whether your procedure or treatment (such as a surgery) is covered under your policy before it occurs, and if there are any conditions that would apply such as an excess. If you think your procedure or treatment is going to cost $1000 or more, or where it will require hospitalisation, you will need to apply for pre-approval. If in doubt, apply for pre-approval.

If you have already have your procedure or treatment, or if it is likely to cost less than $1000, you can make a claim for the procedure or treatment after the it has occurred.

How to get pre-approval for your procedure or treatment

As your procedure or treatment is likely to cost $1000 or more, requires hospitalisation or if you just want to make sure that it's covered under your policy, you will need to apply for pre-approval. To do this, you need to send us the following:

  1. A completed pre-approval form
  2. An estimate of costs for all parts of the procedure/ treatment
  3. A copy of the doctor's referral or specialist’s letter confirming why the treatment is necessary
  4. If you have had your policy with us for fewer than 5 years, we may also require our Medical report form completed by the your doctor (GP). Give us a call if you are unsure if you need to provide this.

Make a claim

To claim for a procedure, treatment or services that has already occurred, you will need to send us your completed claim form along with all invoices and receipts in relation to your procedure, treatment or service.

If the claim is under your surgical or specialist plan, then we will also require a copy of the GP referral letter or a letter from the specialist confirming why the procedure, treatment or service was required. We may also require our Medical report form to be completed by the GP who holds the patient's medical history, if you have not had your policy with us for more than five years. Please give us a call if you are unsure whether you need to provide this or not.

Once we have assessed your claim we will arrange for the payment(s) to be made to your health service provider(s) or reimbursement to yourself. Please be aware that some plans are reimbursement only, so under these you will need to pay the health service provide first, and then we will reimburse you.

Claims Department
Accuro Health Insurance
PO Box 10075
Wellington 6143

E: accuro_claims@accuro.co.nz
P: 0800 222 876
F: 04 473 6187

Claim online

The member portal gives you access to view and edit your personal and policy details online at any time.

Claims and pre-approvals can be submitted through the portal, making the entire process quick and easy and with the option of attaching scanned documents, you get to keep your originals.  To register, all you need is your member number and the email address that is listed on your policy.

Medical report

You may also need a Medical report form to be completed by your GP for your claim or pre-approval.

If it is the first time you are claiming for a medical condition and it is within the first five years of your policy, we will require our Medical report form to be completed by the GP who holds your medical history. This is to give us the history of the condition, as often the GP referral letter or Specialist letter will not provide this comprehensive information we need to complete our assessment, which is why we ask for this Medical report form to be completed.

Processing times

We aim to process your pre-approval within 24 hours of receiving all your information, but it may take up to five working days. Once your procedure or treatment has been pre-approved we’ll send you an approval letter confirming this either by post or email.

We aim to process any claim or invoices within 24 hours of receiving all information, but it may take up to five working day. Please make sure you’re up to date with your premium payments, as if not then we may not be able to provide any payments to you or your health service providers.

If your pre-approval or claim is declined

We’ll send you a letter explaining why your pre-approval or claim wasn’t approved. If you’d like our decision to be reviewed, please read over our complaints process below.

How to make a complaint

We have a four step process to resolving any issues you have.

  1. Call 0800 222 876 to speak with one of our membership specialists.

  2. Put your concerns in writing or speak with a team leader or manager if you don’t feel they’ve been resolved. We’ll acknowledge we’ve received your complaint, investigate and inform you of the outcome within 10 working days.

  3. Write to our CEO, Geoff Annals if you feel your concerns still haven’t been resolved. Your complaint will be acknowledged within five working days from when we receive it. We’ll investigate and get back to you within 10 working days with an outcome.

    Location

    Geoff Annals
    Chief Executive Accuro
    PO Box 10075
    Wellington 6143

  4. Take your complaint to Insurance & Financial Services Ombudsman (IFSO). We provide you with a letter that gives you the option of having your complaint considered by the IFSO. For this to happen, you must have completed the first three steps. You must also contact the IFSO office no later than two months from the date you receive our letter.