# Switching health insurance during pregnancy



## ClubMan (12 Mar 2005)

Say one switches from one health insurer to another and, at the same time, from a "lower" level of cover to a "higher" level of cover during a pregnancy when maternity care has already started - what's the story...

Presumably the maternity waiting period is waived if continuous cover of more than 52 weeks (or whatever it is) has been "served"?   
Will the first insurer pay out benefits for care up to the point of the switch and the second insurer will pay out benefits thereafter?   
Will the enhanced benefits of the "higher" plan be available immediately on switching and, if now, how do they decide what benefits will be available since it's nearly impossible to compare like with like across different health insurers?   
Are you faced with the excess under the first insurer's policy at the start of treatment and the excess under the second insurer's policy or do insurers facilitate only facing the excess once for a course of care/treatment when switching during this time? 
 (Hopefully you can get the gist of what I'm asking above!)

I've tried to read the health insurance policy booklets (_VHI_ don't seem to have theirs on their website any more unless I missed them) and am not clear on the answers to these questions. 

Thanks.


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## terrysgirl33 (13 Mar 2005)

I'm afraid I can't really help with the health insurance question, your best bet may be to try to talk to some one on the phone??  I know some insurance companies waive the waiting period if you are changing from another insurance provider, are you changing under these conditions?

If you want to change from one level to another in a hospital in Dublin (ie, from public to semi to private or whatever), many hospitals wont let you change, particularly if you want to go to private the consultants book up very early...


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## ClubMan (13 Mar 2005)

Thanks for the feedback. 

*I know some insurance companies waive the waiting period if you are changing from another insurance provider, are you changing under these conditions?*

Yes - as far as I know they are obliged to waive the waiting periods once one has previously served them with another insurer. The point is more to do with switching (a) mid treatment and (b) from a lower to a higher plan and what the implications are for (1) excesses (2) higher levels of cover and (3) which insurer covers what for the treatment/care. The issue of changing the level of cover while in hospital etc. is not relevant to my query.


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## ngirl (14 Mar 2005)

Interesting question:

As a result of a promotion at work, I was ugraded from VHI plan B to plan C just before my second pregnancy. When I telephoned VHI, I was informed I would receive VHI plan B maternity benefits during the delivery as there was a 'kicking-in' period of two years before the Plan C maternity benefits would commence. However, as plan B covered the care I received completely anyway, I have no proof that I did not receive plan C benefits.   

The interesting question is, had I transferred to another insurance company, would I have received the upgraded benefits straightaway? 

Let us know how you get on.


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## ClubMan (14 Mar 2005)

*Re: re:Switching health insurance during pregnancy*

Thanks _ngirl_ - will post back if/when I get more info.


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## mo3art (15 Mar 2005)

*Re: re:Switching health insurance during pregnancy*

Hey Clubman, going to answer them all, hopefully, this is my understanding!

Presumably the maternity waiting period is waived if continuous cover of more than 52 weeks (or whatever it is) has been "served"?
Yes

Will the first insurer pay out benefits for care up to the point of the switch and the second insurer will pay out benefits thereafter?
Possibly, the second insurer could pay the whole amount and submit a claim to the first insurer for the amount prior to the switch though

Will the enhanced benefits of the "higher" plan be available immediately on switching and, if now, how do they decide what benefits will be available since it's nearly impossible to compare like with like across different health insurers?
No, a pre-existing condition (I know pregnancy is not an illness) has a "bedding-in" period, and maternity cover is treated in the same manner.  While it's a piece of string question to compare like with like across insurers, most would operate a policy that could be broadly compared with another - So say you are on Plan B with the VHI, then you would benefit from Essential Plus on BUPA for the purposes of the pregnancy.

Are you faced with the excess under the first insurer's policy at the start of treatment and the excess under the second insurer's policy or do insurers facilitate only facing the excess once for a course of care/treatment when switching during this time? I can't say - it's unclear, I would recommend speaking directly to the companies concerned, and definitely get a response IN WRITING!!


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## ClubMan (15 Mar 2005)

*Re: re:Switching health insurance during pregnancy*

Thanks _mo3art_ - your answers concur with the initial feedback from the health insurer apart from the last two points which they haven't yet addressed.


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## brack (16 Mar 2005)

*Re: re:Switching health insurance during pregnancy*

Interesting topic this. 
I'm switching from VHI to VIVAS at the end of this month and there's been various to-ing and fro-ing about who pays for what. 
As baby will be born after I make the switch , VHI wouldn't pay for expenses incurred to date which is a pretty sum when you go private even though I was with them when I incurred the expenses.
But now it appears that VIVAS will pay for all maternity related expenses I have incurred even though I was on the VHI plan when they were incurred....but I have insisted that I get that in writing!
There won't be a waiting period when I move and I will face the excess of only VIVAS


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## ClubMan (16 Mar 2005)

*Re: re:Switching health insurance during pregnancy*

That's very interesting _brack_. When I get some feedback myself I'll post back here.


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## rainyday (17 Mar 2005)

*Re: re:Switching health insurance during pregnancy*



> VHI wouldn't pay for expenses incurred to date which is a pretty sum when you go private even though I was with them when I incurred the expenses.
> But now it appears that VIVAS will pay for all maternity related expenses I have incurred even though I was on the VHI plan when they were incurred....but I have insisted that I get that in writing


Note that neither VHI nor BUPA pay the bulk of the consultant's fee if you go private or semi-private for maternity.


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## ClubMan (18 Mar 2005)

*Re: re:Switching health insurance during pregnancy*

Any rough idea of what they might come to?


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## capaill (18 Mar 2005)

*Re: re:Switching health insurance during pregnancy*

Clubman

Second son born in november.  Wife was private patient in the Coombe.

Note going private does not gaurantee a private room.  Wife ended up on public ward due to there not being any available space in the private ward at the time.

Cost of consultant ex VHI was €1200.  But don't forget you can claim back some of that against your tax bill at the end of the year.

C


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## ClubMan (18 Mar 2005)

*Re: re:Switching health insurance during pregnancy*

*Note going private does not gaurantee a private room. *

Yes - I realise that this is the case with any stay in hospital under health insurance that covers semi-private or private accommodation and that such accommodation is only provided if available. 

*Cost of consultant ex VHI was €1200. But don't forget you can claim back some of that against your tax bill at the end of the year.*

Thanks for that info. I was just wondering what the ball-park figure might be.


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## Ceann Comhairle (18 Mar 2005)

No one here has asked yet but doesthis question meanthat congratulations are in order?  A potential Bohemians player in the making?


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## ClubMan (18 Mar 2005)

Yes as it happens. Thanks. Not sure about the _Bohs_ player bit although we'll do my best to raise a fourth generation of _Bohs_ supporter since we all need a cross to bear in life.


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## mo3art (18 Mar 2005)

Well congratulations Clubman!


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## sueellen (18 Mar 2005)

*Re: Congrats to you both.*

Clubman,

Sincere congratulations to you both. Happy days ahead.

Sueellen.


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## ClubMan (18 Mar 2005)

*Re: Congrats to you both.*

Thanks a lot everybody.


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## Vanilla (18 Mar 2005)

*Welcome to the parents club*

Congratulations!


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## terrysgirl33 (21 Mar 2005)

*Re: Welcome to the parents club*

I'll add my congrats too!

FWIW, I don't know what hospital you are going to, or where you live, but when I was pg on #1, I rang around the main Dublin hospitals and found them very helfull and clear about fees and what was covered by the various health plans.  If you are going private (I think) the fees vary from one consultant to another, so you may need to have an idea of who you are going to.  But the accounts department in the hospital were very helpful.


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## ClubMan (21 Mar 2005)

*Re: Welcome to the parents club*

Thanks a lot. As it happens we're switching from _BUPA_ back (after several years absence) to _VHI_ because that's what's offered by my job. I'd prefer to stay with _BUPA_ based on past experience but they're paying so I don't want to look a (_BIK_ taxable) gift horse in the mouth. The _VHI_ rep. that I spoke to said that (a) there was no problem in switching, (b) that if non-public treatment/care had already been initiated (I don't think that this is the case and believe that treatment/care to date has been under the public health system) then _BUPA_ would meet the initial costs with _VHI_ taking over once we switched (c) that the maternity cover waiting period didn't apply since we had already "served" it with _BUPA_ and (d) that enhanced cover under the _VHI Family Plus_ plan versus the existing _BUPA Essential Plus_ plan would kick in immediately. I have requested a copy of the detailed terms & conditions to check all of this since they don't seem to be available from the _VHI_ website but if most or all of this is true then it seems fine, even if (d) is a little surprising to us! In relation to charges the _VHI_ rep., in common with others here, mentioned that the likely semi-private/private cost over and above that covered by insurance was likely to be for the consultant and to come it around the Eur 1-2K mark with tax relief available on most of it. If anybody has any relevant information on this topic please feel free to post it. Thanks.


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## rainyday (21 Mar 2005)

*Re: Welcome to the parents club*



> In relation to charges the VHI rep., in common with others here, mentioned that the likely semi-private/private cost over and above that covered by insurance was likely to be for the consultant and to come it around the Eur 1-2K mark with tax relief available on most of it.


Many congratulations to yourself & herself, Clubman. The estimate for the consultant fee seems low. If I recall correctly, it was over €3k for our private consultant's fee last year. BUPA refund a small piece of this on their outpatients scheme and HSA covered another chunk of it too.


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## michaelm (5 Apr 2005)

I would expect your private consultant fee, in a public hospital, to be 2K (they will also bill your health insurer about €250).  Until capaill's post I have never heard of any private patient ending up in a public ward and I remain a sceptical, also €1200 look too cheap; perhaps capaill your experience was related to semi-private care?. RainyDay's 3K looks expensive, unless that was in a private hospital/clinic. It is quite possible for a private patient to end up on a semi-private ward although this might prove a better experience for a first-time mother as there is more comings and goings from the nurses etc.


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## legend99 (20 Apr 2005)

Clubman,
My wife is currently 'in the family way' as well. Shes is going to consultant privately, but as it does his deliveries in Public hospital she will be entitled to the full cost of hospital stay covered, and in theory should get a private room in puiblic hospital. As they have one private room she'll need to be lucky to get this so you usually end up sharing. its the Erinville in Cork.

On her first visit to the Consultant she was told his fees were 2k and that the VHI would cover 255 of this. Thats the plan B amount. However, as I am on Plan B Options this would actually be 385. 
However, this is where it gets complicated for me as well. In work, we are being switched over to Family Plan plus effective May 1st. On this plan the VHI pay 650 towards pre/post natal consultant visits. My wife is due in August. Now she hasn't paid anything yet but it was strongly hinted to her that she should pay the full 2k on her next visit, which is first week of May. 

Now first off I don't know if the consultant bills the VHI direct and that we pay the balance, or that we pay the full 2k and look to claim money back. From being on the phone to the VHI  I think we are entitled to the 650 amount as opposed to the 385 as there is no waiting period for this.

However, the girl also said that there was an increase from 1600 to 2000 towards the cost of hospital cost if you were in a private hospital having the 
baby but she indicated to me that my wife would not be eligible for the higher 2000 allowance as this DID have a waiting period. 

I hope that helps somewhat, and if anyone knows if you pay the consultant direct before claiming the money back or if you only pay you the lower amount and he claims the other part direct I'd appreciate that!!!


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## legend99 (1 Jun 2005)

Clubman, you get anywhere else with this?


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## ClubMan (1 Jun 2005)

Well, we switched from _BUPA _(me on _Essential New _and herself on _Essential Plus_) to the work _VHI _scheme (_Family Plan Plus_). Any expenses incurred to date (€200 for a non routine scan and triple test) are not covered by either so any reclaimable expenses will only be incurred later on and the claim will be submitted to _VHI_. As far as I know there is no major difference between the cover available under the two plans. 

On a related point - we were never asked or billed by the hospital for the [broken link removed] that we expected to be levied. Is this unusual?


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## ClubMan (14 Oct 2005)

*Re: Welcome to the parents club*



			
				rainyday said:
			
		

> Many congratulations to yourself & herself, Clubman. The estimate for the consultant fee seems low. If I recall correctly, it was over €3k for our private consultant's fee last year. BUPA refund a small piece of this on their outpatients scheme and HSA covered another chunk of it too.


We haven't received a bill from the _Rotunda _yet but a notification from _VHI _came today itemising the charges arising and what was remitted by _VHI_ directly to the hospital and the shortfall was €500. I don't have the detailed breakdown to hand so I can't say specifically what this related to. To date we have not paid anything to the hospital other than €200 for the scan and triple test mentioned above which were not covered under the public health service or by our insurer.


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## ClubMan (20 Oct 2005)

Oh - as it turns out the shortfall of €500 is irrelevant - the charge in question for obstetrician was about €913 and _VHI _paid €413 but because the _Rotunda _deals directly with _VHI _on these charges the lower benefit paid out is taken as full payment for the services rendered. This means that there are no outstanding in-patient charges that we have to cover. We will presumably be billed separately for ante-natal semi private care by the _Rotunda _which, I believe, is not covered but qualifies for tax relief.


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## ClubMan (18 Nov 2005)

So - the latest installment. In spite of what I posted above it turns out that the _Rotunda_ (for the second time in three years) sent us effectively final notice demand for the outstanding €500 and berating us for not having paid this on admission (as I mentioned before) in spite of the fact that (a) nobody ever asked us for this at any stage over the pregnancy (b) we were never invoiced by the hospital (as opposed to being notified by _VHI_) for any charges relating to the pregnancy (c) when we left the hospital after the delivery stay I specifically asked if we owed anything and was told that we didn't and that the VHI form would cover everything and (d) the charges listed on the invoice do not match those displayed on their website. We had nothing but praise for the actual care that we received in the hospital over the pregnancy  but based on this second dodgy invoicing experience with them their patients' accounts department don't seem to know what they're doing. We are perfectly willing to discharge our liabilities with them but only on the basis of being invoiced properly for the relevant charges and not being blamed for their incompetence in not collecting this charge earlier. We have made a formal complaint (as we did the last time only to be told that the invoicing mistake - a letter threatening legal action even though we had not been invoiced that time either and all the charges had been paid by _BUPA_ anyway - was an aberration made under mitigating circumstances) to the hospital again.


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## Henny Penny (24 Nov 2005)

Someone I know opted for public care ... for the first 7 months or so ... and then upgraded and become a private patient closer to term. 
The only advise I can give is try to use a maternity hospital rather than a private hospital for the best standard of care. It makes sense that the more births a hospital has, the better equipped they will be to opt for eventualities. I speak from experience having had one child in Mt. Carmel, my second was born in the Coombe. Also if you opt for a private hospital you will be eligible to pay all fees for ultrasounds, blood test etc.


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## hullabaloo (5 Dec 2005)

Hi,

Congratulations! I'm not answering your questions above but for any first timers the following points are of interest: 

It may be a long way off yet but don't forget to call your health insurer when babs arrives as even though they claim babs is covered until next renewal date, they will not accept any claims for babs unless he/she is named on the policy at the time of the expense. (Typically you would incur a 75 euro charge for a private paediatric check-up after six weeks).

Also please note that even if you are going privately it is still well worth considering going down the combined care route with your local doctor. This is especially useful AFTER babs is born because babs and mother have six weeks of free care with the local doctor and that can be especially useful if you live a long way off from the maternity hospital (which also covers babs and mother for six weeks).  

L.


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## ClubMan (9 Feb 2006)

ClubMan said:
			
		

> So - the latest installment. In spite of what I posted above it turns out that the _Rotunda_ (for the second time in three years) sent us effectively final notice demand for the outstanding €500 and berating us for not having paid this on admission (as I mentioned before) in spite of the fact that (a) nobody ever asked us for this at any stage over the pregnancy (b) we were never invoiced by the hospital (as opposed to being notified by _VHI_) for any charges relating to the pregnancy (c) when we left the hospital after the delivery stay I specifically asked if we owed anything and was told that we didn't and that the VHI form would cover everything and (d) the charges listed on the invoice do not match those displayed on their website. We had nothing but praise for the actual care that we received in the hospital over the pregnancy  but based on this second dodgy invoicing experience with them their patients' accounts department don't seem to know what they're doing. We are perfectly willing to discharge our liabilities with them but only on the basis of being invoiced properly for the relevant charges and not being blamed for their incompetence in not collecting this charge earlier. We have made a formal complaint (as we did the last time only to be told that the invoicing mistake - a letter threatening legal action even though we had not been invoiced that time either and all the charges had been paid by _BUPA_ anyway - was an aberration made under mitigating circumstances) to the hospital again.


 For some reason we have still not heard back from them since the _Complaints Manager _acknowleged our complaint (actually complaints - since we had another about being surreptituously and presumptuously being registered as _"Roman Catholic" _on admission without being asked) in December but the ball is in their court and they need to issue a proper invoice (not a hand scrawled bit of paper) before we pay the €500 that we presume that we owe them. If they don't get back to us then we will not be volunteering to pay this charge.

As I mentioned to somebody recently, in spite of all the problems that we hear about with the health service, I/we have had no problems with the medical care side of things in the past decade or so but the administrative/billing side of things seems to be a bit chaotic...


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## Kiddo (9 Feb 2006)

ClubMan said:
			
		

> As I mentioned to somebody recently, in spite of all the problems that we hear about with the health service, I/we have had no problems with the medical care side of things in the past decade or so but the administrative/billing side of things seems to be a bit chaotic...


 
A friend of mine was attending the Rotunda as a semi private patient on her second pregnancy and had paid her €500 deposit. Unfortunatly she suffered a miscarriage. 

As she was waiting to see the doctor a week later (for whatever procedure is necessary in these circumstances), someone from accounts came to her and asked if she wanted a refund of the €500 or should they hold onto it for her next baby ...talk about insensitive ..so nothing would surprise me about their admin system.


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## ClubMan (9 Feb 2006)

Wow - that's pretty insensitive alright. I'll keep you posted on our issue..


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