Everything you need to know about how to claim
Find out what a claim and pre-approval is, why you might need to get pre-approval for an upcoming procedure or treatment, and how you can claim for your medical costs.
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.
Claim or Pre-approval?
There are two ways that you can claim for your procedure and/or medical treatment.
1) Request Pre-approval
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?
2) Submit a Claim
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 had 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 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:
- An estimate of costs for all parts of the procedure/ treatment
- A copy of the doctor's referral or specialist’s letter confirming why the treatment is necessary
- If you have had your policy with us for fewer than 5 years, we may also require our Medical report form to be completed by your doctor (GP). Give us a call if you are unsure whether you need to provide this.
Alternatively, you can complete a pre-approval form and email it, along with the above information, to claims@accuro.co.nz. Be sure to write Pre-Approval in the subject line.
Make a claim
To claim for a procedure, treatment or services that has already occurred, you will need to send us a copy of all invoices and receipts related 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 provider first, and then we will reimburse you.
Alternatively, you can complete a claim form and send this, along with the above information, to claims@accuro.co.nz.
Claims Department
Accuro Health Insurance
PO Box 10075
Wellington 6143
E: claims@accuro.co.nz
P: 0800 222 876
F: 04 473 6187
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 three working days of receiving all of 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. 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.
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Tell our team: Please raise your concern by contacting one of the team at Accuro on either complaints@accuro.co.nz or by calling 0800 222 876.
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Escalate to the manager: If your concern has not been resolved through the first step, then please put your concerns in writing to the Customer Manager care of complaints@accuro.co.nz or call us on 0800 222 876. The Customer Manager, or other appropriate Manager, will investigate your concern and endeavour to come back to you with a decision within 10 working days.
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Seek complaints committee review: If your concern remains unresolved, then please write to our Complaints Review Committee at complaints@accuro.co.nz who will arrange a thorough review of your concern and provide you with a written decision. We will endeavour to provide a response within 10 working days.
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Go to our Ombudsman: If your concern has not been resolved through the first 3 Steps, we will provide you with a deadlock letter, which you can use to take a complaint to the Insurance & Financial Services Ombudsmen (IFSO). To go to the IFSO, you must have worked through the first 3 Steps of the complaints process with us, and then you must contact the IFSO office within 2 months from the date of the deadlock letter we provide you or, if for some reason the deadlock letter has not been provided, within 3 months of your initial complaint to us.
Feel confident about your diagnosis or treatment plan
As a member of Accuro, you have free access to a second opinion from the best medical experts in the world. Have peace of mind that you have all the information you need to make the best decision for your health.
Your report will include:
- A summary of your condition
- An explanation of the outcome of any tests
- Treatment options and the pros and cons of each one
- Reliable links to additional resources
This service is powered by Teladoc Health and is completely independent and confidential. Accuro will never know that you have used this service unless you choose to tell us.