Contact us about health insurance

Complaints process and disputes resolution scheme

If you’re dissatisfied with the financial advice service provided by or on behalf of Southern Cross, you can raise your concern directly with any of our nominated representatives, or by:

• Calling us on 0800 800 181
• Using our online complaints form
• Writing to us at: Complaints at Southern Cross, Southern Cross Health Society, Private Bag 99934, Newmarket, Auckland 1149.

We’ll acknowledge receipt of your complaint within two working days of the date we receive it (or if it is not practicable to do so, as soon as practicable after that time). We’ll aim to resolve your concerns in a timely manner and we’ll keep you informed of our progress.

So that we can best address your complaint, we may refer your complaint to different teams within Southern Cross. We will respond to you with the outcome of our investigation in a timely, fair and transparent way.

If you’re unhappy with our response, you can request that your complaint be reviewed by the Chief Operating Officer of Southern Cross. The Chief Operating Officer will review and make a final determination in respect of your complaint, which will be communicated to you as soon as possible.

Still not satisfied?

We belong to the Insurance & Financial Services Ombudsman’s approved dispute resolution scheme (IFSO). The IFSO Scheme is a free and independent dispute resolution service available to consumers that may help investigate or resolve complaints if not able to be resolved through our internal complaints process.

If your complaint has been fully investigated by us and you’re still not satisfied with the outcome, you can refer your complaint to IFSO for review.

You can contact the IFSO Scheme on 0800 888 202, email at info@ifso.nz or at www.ifso.nz.

Alternatively, you can write to: Insurance and Financial Services Ombudsman, PO BOX 10 845, Wellington 6143.

If you are concerned about potentially suspicious health insurance claiming, you can get in touch with us by:

• Calling our toll free number 0800 420 055
• Using our reporting suspicious activity form

Below are some examples of suspicious claiming we would investigate:

• Intentionally fabricating or altering invoices and receipts
• Submitting claims for treatment that differs from what was provided
• Billing for treatment that was not provided to obtain reimbursement
• Unexpected claims activities on your policy

We will use the information you provide to look into your concerns carefully and sensitively, and will take all practicable steps to maintain strict confidentiality.

If you wish to access or correct any personal information you provide us, then please let us know.

You do not need to fill in all sections of this form and if confidentiality is a concern, you can choose to remain anonymous, however the more information you can give us, the more likely we’ll be able to do something to investigate the matter further.

How can members help?

• Never sign a blank form and leave it with anyone – even a healthcare provider.
• Carefully check the details on invoices and your Claim Update to ensure they match the treatment received and costs paid.
• Don't be afraid to ask questions, report issues and query invoices if you see anything suspicious in your claims history.

How can providers help?

• Ensure staff are properly trained to submit prior approval and claims on behalf of our members via our Affiliated Provider or Easy Claim portals
• Ensure Eligibility Criteria has been met prior to submitting an application or claim
• Ensure any ACC claims are submitted to ACC in the first instance
• Tell us about any refund or discounts that have happened from the original claim
• Ensuring you are using the correct date and items/codes/procedure codes on every claim
• Do not share your password and remember you are responsible for claims using your provider login
• Let us know if you are feeling pressured to make a claim
• Use our reporting form and tell us about suspicious behaviour

Our approach

If suspicious claiming practices are suspected, the Society investigates and where appropriate takes steps to recover funds. The Society has a range of actions that it is able to take against members and providers. In extreme cases, where fraud or ethical issues are suspected, matters may also be referred to the police or an appropriate medical body.