After an injury, your family doctor or physiotherapist will typically register the injury with ACC, who will contact you to say you are covered. This cover will pay for the cost of your appointment with Mr Young, as well as any scans or x-rays that are required. It will also contribute to the cost of any physiotherapy.
If surgery is required due to an injury covered by ACC, Mr Young will make a special request for funding to ACC (Assessment Report and Treatment Plan or ARTP). ACC will then examine your case more closely before approving funding for the surgery. This approval process can take from 2-8 weeks, depending on the complexity of your case.
Once ACC have approved the surgery, a date can be scheduled with Mr Young. ACC will also contribute to your physiotherapy costs and any loss of earnings during your recovery.
Sometimes ACC will decline the request for surgery, usually if they feel your condition is not due to an injury or that a ‘degenerative’ process, such as arthritis, is a significant part of the cause of your symptoms. An ACC decline can be stressful, and sometimes hard to understand as can be difficult to say exactly how much an injury or accident directly caused your condition.
After an ACC decline, they will fund a further appointment with Mr Young to discuss your options.
APPEALING AN ACC DECISION
You can appeal the decision, the ACC website outlines the steps here. There are also patient advocates available to assist with this process, visit this page on the ACC site to find out how. If you have private health insurance, often your insurance company will organise the appeal process for you.
WHAT IF I HAVE INSURANCE?
If your condition is due to an accident, your insurer will expect that ACC to fund your surgery. This benefits you, as ACC will pay compensation for loss of earnings during your recovery, which private insurance generally does not cover. ACC also contribute to the cost of your physiotherapy.
Unfortunately, this means you need to wait for ACC to approve funding (anywhere from 2-8 weeks) before you can proceed with surgery.
If your condition is not due to an accident, then you do not need to wait for an ‘ACC decline’. Mr Young will write a letter to your insurer stating your condition will not be covered by ACC.