# VHI - what CAN I claim?



## muffin1973

Hi all,

Am getting thoroughly confused with what I can and can't claim back through VHI.  I had cause to claim a few things back three years ago, and I was able to send in the form and they would then pay the hospital.  I've recently had to get a couple more things done, and have had two more bills.  

My consultant's receptionist filled in a VHI claim form for one of the procedures I had done and got me to sign it - that seemed simple enough.  I've just got a bill from Medserv for the other procedure and rang VHI to see if I could claim it but he says I have to wait till the end of the year to claim it????  I'm so thoroughly confused, I don't understand how I could claim for one procedure but not another (very similar) one?

Can anyone offer any clarification on it?  It all seems very complicated 

M


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## huskerdu

VHI pay for hospital in-patient procedures directly to the consultant and hospital. 

Out-patient claims like doctor visits and consultant visits must be done in an out-patient claim at the end of the year. 

I dont know the details of what you had done, why one would be an in-patient claim and one an out-patient claim.  

Who are Medserv and what service did they provide to you ?

You also have not stated what VHI plan you are on, as the amount of out-patient befenits available varies widely from plan to plan.


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## muffin1973

Hi Huskerdu

Thanks for your reply, that clarifies things a bit.

Firstly, I'm on Plan D. Medserv did nothing for me - just sent me the bill from the radiologist for the ultrasound I had. They look like a billing service. 

The way you explain it, makes it even stranger that the two procedures would be claimed for differently. Both were carried out in the hospital, one by my consultant and one by a radiologist, wouldn't this mean they were both in patient claims? I mean, I know I have to directly pay to see my consultant, but not for the procedure he had to carry out. So why can't I just claim for the second procedure (carried out by the radiologist) in the same way?

Think will give VHI another ring and see if they can clarify it at all - the first guy I was talking to started going on about 'excess', which I don't think I was asking about at all. 

Anyway, thanks again

M


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## NovaFlare77

Ultrasounds, when carried out on their own, are an out-patient cost and would be claimable at the end of the year, subject to your out-patient excess.

If an ultrasound is carried out while a patient in hospital then the cost is included as part of the bill sent by the hospital to your health insurer.

In your case, it sounds like you had a procedure carried out by a consultant in his rooms or the hospital's out-patient department. Am I correct in thinking that the ultrasound was carried out after the first procedure (i.e. not on the same day)?

If it was carried out on a different day, then chances are the ultrasound cost isn't included as part of the consultant's agreed rate with VHI and therefore you are liable.

To be 100%, before you contact VHI, get in touch with the consultant who carried out the first procedure and ask them for a "procedure code". This is the number VHI have assigned to the specific procedure you had done. The secretary should be able to give you this as it has to be completed on the form going to VHI. 

Then when you get back to VHI, explain that you had the ultrasound carried as a resullt of the first procedure, give them the procedure code and when they look the code up, ask them if an ultrasound is covered as part of the procedure.

NB I'm making some assumptions about the timing and reasons for the ultrasound so if any of these are incorrect, things will probably be different.

EDIT: FYI, Medserv are a billing service, if it's the same company as this one.


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## muffin1973

Hi Nova

no, you're right, the ultrasound was the second procedure and was carried out 3 days after the first one.  My consultant thought I might have PCOS so referred me to the radiologist for the TV scan - not necessarily linked to my first procedure (colposcopy) but all gynacological so possibly linked?

Yes, medserv is the same as the link you posted.

thanks

M


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## scals

Just wondering do you HAVE to wait until the end of the year to claim outpatients??  I've had huge medical bills already this year and would love to get some of it back.  

does that also apply to the portion of the consultants and gp fee that are claimable??  Am with vhi plan b options.


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## extopia

A VHI customer service person told me recently that claims can be made at any time as long as they're on the correct form, which can be downloaded from the vhi website.


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## NovaFlare77

muffin1973 said:


> Hi Nova
> 
> no, you're right, the ultrasound was the second procedure and was carried out 3 days after the first one. My consultant thought I might have PCOS so referred me to the radiologist for the TV scan - not necessarily linked to my first procedure (colposcopy) but all gynacological so possibly linked?
> 
> Yes, medserv is the same as the link you posted.
> 
> thanks
> 
> M


 
Even though they are related to the same condition, they are treated as two different procedures by VHI and therefore assessed accordingly. Sorry to say, but the ultrasound bill is an out-patient service so it looks like you need to pay for it and send your receipts, along with GP and consultant, etc to VHI after your next renewal. 

One other thing to be aware of is that you _may_ get a second bill for the ultrasound, it being from the hospital. For radiology (such as an ultrasound or x-ray, etc) there are two charges: the professional charge from the radiologist and the technical charge from the hospital/centre in which the scan was carried out. However, if the scan was carried out in a public hospital, even as a private patient, there will be no hospital charge. Also, your bill from Medserv might already have included this, in which case you can ignore this paragraph!

Sorry I don't have any good news, but I'd suggest ringing VHI anyway. I used to work in health insurance, but that was about three years ago so things may have changed since. If it is a case of waiting until the end of the year, then make sure you claim tax relief on these medical costs.





scals said:


> Just wondering do you HAVE to wait until the end of the year to claim outpatients?? I've had huge medical bills already this year and would love to get some of it back.
> 
> does that also apply to the portion of the consultants and gp fee that are claimable?? Am with vhi plan b options.


 
Assessing bills at the end of the year makes it's easier to see if you're due anything after your excess. But I have heard of exceptions being made in the case of high medical expenses.

Just to clarify as well, the waiting until the end of the year only applies to out-patient costs. If you've been in hospital for surgery or procedures then get onto VHI straight away and make sure claims for all future surgeries are sent directly to VHI.


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## ebowdia

I have Company Plan Plus, with my subscription year ending each year in August. I have outpatient receipts for last year for May and June that I have not claimed back yet - is it too late to do it now?


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## extopia

No, it's certainly not too late.


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## ebowdia

Just called them there and they will accept all receipts back as far as Jan 1st 2007.


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## muffin1973

Hi Nova,

Thanks for the info, so I'll have to wait till the end of the year to claim for the ultrasound and just send them a cheque now.  Main thing is nothing is wrong I guess so will pay up  

Just found a load of GP receipts from 2007 - could I claim back money on these?

thanks again guys

M


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## extopia

muffin1973 said:


> Just found a load of GP receipts from 2007 - could I claim back money on these?



It depends on whether you're covered for outpatient expenses or not. Check with your plan documentation or on the VHI website. If you're covered, yes, you can and should be claiming these back. I get back €40 per GP visit, for example.


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## Bingoo

I have receipts dating back to 2006 which I am in the process of claiming.   Will these not be accepted? Bupa accept claims back for 10 years!  When were we informed by VHI that they only accept receipts up to 2 years? I can't see it written anywhere on their website.


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## scuby

just get a claim form and complete it and attach receipts and send it to them..


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## Bingoo

I sent my 2006 receipts off today to VHI.  Hopefully they'll pay up.  I'll post here when I get word back.


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## dewdrop

I in my innocence found  the Out Patients Claim Form to be misleading at least as far as i was concerned. Say you have an option plan and this entitles you to20 euro for a doctor visit which will probably cost you 60 euro. If say your total entitlements  come to 25O euro which the VHI refer to as Eligible Expense you have to deduct an Excess of 220 Euro so according to my reckoning you would only get back 30 euro. Wrongly i thought the system in some way related to the actual outlay incurred.


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## scuby

what you get back depends on your policy. most policies are mainly for hospital cover, some have a bit of both, and others give more back for Dr visits....


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