# Cardiac MRI: hospital said I was covered but insurance company say Im not.



## agencydude (28 Jul 2013)

Hi 
About 2 years ago I went for a cardiac MRI scan in a Dublin hospital as an out patient.

I was doing a series of health checks at the time. My health insurance company advised me to pay upfront and claim back later when doing these health checks.

Prior to  doing the cardiac MRI scan I rang to see how much that particular test would cost and was informed by  the  appointments office receptionist  in the hospital  that they had an existing arrangement  whereby the insurance company paid the hospital directly.

So I went ahead and did the cardiac MRI scan.

A year later I got a letter from my health insurance company to say I was not covered for the cardiac MRI scan at that particular hospital. They say I'm not covered  as I didn't get prior approval from the insurance company and the hospital in question is not approved for MRI cardiac scans.

Now I'm getting monthly reminders to pay the bill from the hospital.

The first issue here is that I believe I was totally mislead by the hospital staff.

If I had known I was not covered I would have gone to some other hospital approved by the insurance company to get the test done.

 The second issue  here is that  the insurance booklet I had at the time stated the hospital was an approved MRI scan centre.

However, the insurance company are saying that the hospital is not an approved 'Cardiac MRI scan'  centre. 
Basically the booklet did not distinguish between an 'Cardiac MRI scan centre' and a 'MRI scan centre' 

I've already complained to the insurance company via their complaints process. They say they're still not covering me and I should make a complaint to the financial services ombudsman If I'm still not happy.

So what do I do now ? Any advice?

Should I make a complaint to the hospital for misleading me?
If so how should I do this?


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## oldnick (28 Jul 2013)

unless one were to study every detail of the VHI policy -small print etc - plsu anything you may or may not have signed , then nobody can give you 100% advice.

However....

Based on what you have stated there seems little doubt that you are blameless and that it is between the hospital and VHI to sort this out.
If VHI refuses to pay hospital then that is hospital's bad luck based on their wrong advice to you - albeit that this wrong advice may have been caused by VHI.
It's their problem not yours.

Send a s strong letter to the hospital telling them to stop bothering you.
I wouldn't bother with any ombudsman unless hospital  got really nasty.

... and don't get upset about continual  threatening reminders.


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## Sue Ellen (28 Jul 2013)

I wouldn't ignore any bill these days.

The approval should be obtained from the insurance company and preferably by e-mail as these tests can be quite expensive.

If you have the name of the person that you spoke to in the hospital it will strengthen your case.  You could try pursuing it with the hospital either way.

If this does not work the Ombudsman is your only option.

I had a problem with VHI where they gave me wrong date qualification but I was able to send them a copy of the e-mail confirmation and they then backed down.


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