# VHI & Approved Centres



## annet

There are changes to the list of approved centres for VHI customers.

Euromedic in Northwood is no longer an approved centre for scans etc if you are a VHI customer. 

As from September (I think), Euromedic/Northwood in Dundrum will also not be on the approved list.


----------



## NovaFlare77

VHI's list of approved MRI centres changed last November and at that stage Euromedic Northwood was removed. The Dundrum centre is still on it though, and VHI is slow to change the list of MRI centres once it's set unless something serious happens (the list is valid for two years). Do you have a source or a link for dundrum coming off the list?

The current list is in the back of the rule books if anyone is looking for it.


----------



## annet

*Source*

The source was VHI.


----------



## NovaFlare77

I saw this on the [broken link removed]:



> *Euromedic Ireland would like to advise its patients and referrers that VHI cover for CT scans in Euromedic Dundrum is currently under review with the VHI pending a decision in the coming weeks.* In the interim period, Euromedic Dundrum is offering a special CT price for standard CT scans of €175, effective from today (2nd July 2010), until further notice.
> 
> The price is approximately half the cost of CT scans provided by other operators. It has been put in place to facilitate direct paying patients who need affordable scans quickly.
> 
> Euromedic Dundrum has operated the only direct settlement VHI CT contract in Ireland for the last five years. Approximately 6,500 CT scans are performed annually at Euromedic Dundrum on referral from a medical practitioner. All patient records for CT scans are retained in Euromedic Ireland's secure database, to ensure continuity of care in repeat CT scans.
> 
> The CT price on offer covers standard CT scans, with or without contrast. Prices for more complex CT scans may vary. Quinn and Aviva Healthcare cover remains the same. Please check with your provider for details.
> To make an appointment for a CT at Euromedic Dundrum, please contact: 01 213 5959 or fax a referral letter to 01 213 0950.


 
I wonder if the VHI person that the OP was speaking to might have meant this?

If it is, it might be a bit of a legal headache for VHI to change this. Normally, changes to insurance terms and conditions only apply at a person's renewal, unless the insurer has specifically built in that something may change at certain times. For example, VHI says that changes to the hospital list will be published in the papers and the list of approved MRI centres is valid up to November 2011.

However, the rule about CT cover in this centre (formerly known as Advanced Radiology) doesn't mention anything about changes, so the normal process would be it can only change at renewal. Given that the renewals are throughout the year, it would mean that *if* VHI decided today to change it, it would be August next year before it would apply to ALL their members. Members that renewed in the last 12 months would still be entitlted to CT cover there until their next renewal.

This is all conjecture of course; nothing may change and I might have missed something else in the terms and conditions. And if any change made is for medical safety reasons then I don't think anyone could reaonably object to it, but it will be interesting to see how VHI will implement the change should one be coming.


----------



## amgd28

As I understand it all the recent 2-year contracts VHI awarded for radiology services incorporated a cap on activity, which was generally lower than normal demand. I would assume that this is what Euromedic are referring to as the demand for MRI's and CT's has obviously been in excess of the demand that was set by VHI and so once they go beyond this threshold they would receive no furher money from VHI for such claims. As a result, they are ceasing cover unless VHI continue to cover their patients. 
At least that is what I suspect is going on as I have seen such situations in the market before - I have no specific insight into this particular case


----------



## NovaFlare77

Just a quick update on this if anyone's interested. 

VHI have published their September 2010 rule book and any reference to full cover for CT scans has been removed, so this cover is no longer available to VHI members at renewal, starting with September renewals. The link to the Plan A to E rule book is here - http://www.vhi.ie/pdf/products/memberhbook_Sept10.pdf.

The MRI list seems to be unchanged.


----------



## olddog

Novaflare77,

This is very interesting

I called the VHI earlier today attempting to confirm that I would have full direct payment cover for a CT scan at Euromedic, Dundrum.

My renewal date is 1st August & on last renewal changed from E to Co plan Exec

A guy in 'VHI claims' told me that I would not be covered & that their direct payment contract with Euromedic had ceased

The T&C &c that the VHI sent me at the time of renewal state that I had full direct payment cover for this


Is this correct ?

Can VHI just stop part of their insurance offering four months after I buy the policy for a year without offering an equivalent service elsewhere ?


Sorry to drag up an old thread - but it is exactly related to my present issue


Olddog


----------



## scuby

afaik, changes can be announced through national news papers mid year by an insurance company, if cover has changed for a hospital


----------



## yves

VHI apparently have no direct payment arrangements with any hospital for CAT or PET CT Scans. Aviva do though and have a big list and Quinn have a limited number.


----------



## NovaFlare77

olddog said:


> Novaflare77,
> 
> This is very interesting
> 
> I called the VHI earlier today attempting to confirm that I would have full direct payment cover for a CT scan at Euromedic, Dundrum.
> 
> My renewal date is 1st August & on last renewal changed from E to Co plan Exec
> 
> A guy in 'VHI claims' told me that I would not be covered & that their direct payment contract with Euromedic had ceased
> 
> The T&C &c that the VHI sent me at the time of renewal state that I had full direct payment cover for this
> 
> 
> Is this correct ?
> 
> Can VHI just stop part of their insurance offering four months after I buy the policy for a year without offering an equivalent service elsewhere ?
> 
> 
> Sorry to drag up an old thread - but it is exactly related to my present issue
> 
> 
> Olddog


 
My understanding is that unless the benefit has a specific provision for a mid year change, then the benefit should apply until the next renewal. VHI can change directory of hospitals and out-patient centres at any stage by an advert in the papers, but given that the Dundrum centre was never listed as an o/p centre, this doesn't seem to apply in this case. 

Assuming you haven't had the scan yet, my advice would be to contact VHI again and ask them to direct you to the part of the rules where it's stated that this centre can be removed mid-year. The CT Scan benefit is built directly into the rules and it isn't part of any directory, so my call is that the change can't come into effect until your next renewal. (As always, there's the chance I coul dbe wrong, that's why I'm suggesting that VHI tell you how this change can be made within the terms of their rules.

Even if you've had the scan, I think a case could be made that VHI should cover a portion of it, outside of what they would cover on your out-patient benefit.


----------



## NovaFlare77

yves said:


> VHI apparently have no direct payment arrangements with any hospital for CAT or PET CT Scans. Aviva do though and have a big list and Quinn have a limited number.


 
Yes and no. VHI don't have any direct payment agreements for CT scans, but they have agreements with 6 private hospitals for PET-CT scans (PET-CT scans are different from standard CT scans and far more advanced).


----------



## scuby

as per rule 2g, hospital cover may change mid year, see attached from rules :

page 3 of link : http://www.vhi.ie/pdf/products/memberhbook.pdf
(g) We may change these directories and schedules during the year. The most up-to-date Directory of Hospitals is available on our website - www.vhi.ie.
We will tell you about changes to the Directory of Hospitals (and Treatment Centres) at least four weeks beforehand by publishing a notice in the major
national daily newspapers. If you want to cancel your contract because of any such change, you can do this by writing to us within four weeks of the
date we publish notice of the change


------------------------------------------------------------------------------
Rule
(aj) Out-patient CT scans If the patient attends the Advanced Radiology Centre for out-patient CT scans (with GP or Consultant referral) payments
will be made directly to the centre and will not be subject to an excess

above is from page 8 of the attached from vhi site
http://www.vhi.ie/pdf/products/companyPlan_Rules_Jan10.pdf
not sure what policy OP is on, but would always call first prior to going for scans etc incase terms and conditions may have changed mid year


----------



## NovaFlare77

But, as per my earlier post, the Dundrum centre was never listed in the  Directory of Hospitals and Treatment Centres printed in the back of the rulebooks. It was only mentioned in Rule AJ. So arguably the rule about changes to hospital directories isn't relevant in this case because there isn't a Directory of CT Scan Centres.

But even if it was in a Directory, did VHI publish a notice of the change in the national papers? (That's a general question, not just directed at scuby.)


----------



## yves

NovaFlare77 said:


> Yes and no. VHI don't have any direct payment agreements for CT scans, but they have agreements with 6 private hospitals for PET-CT scans (PET-CT scans are different from standard CT scans and far more advanced).


 
Where are you getting that information from? VHI have said that they no longer have any direct payments for CT or PET-CT scans? Aviva's website say that they cover 6 PET-CT centres.


----------



## NovaFlare77

That's the information in VHI's current rule book for Plans A to E here, page 6:


*PET-CT Scans 
*Benefit for PET–CT scans is available to members subject to the following criteria:
• Prior Approval
• The member is referred for a PET-CT scan by a consultant
• The PET-CT scan is carried out at Beacon Hospital, Blackrock Clinic, Galway Clinic, Mater Private Hospital, Whitfield Clinic
or Hermitage Medical Clinic​• The PET-CT scan is carried out for one of the clinical indications as specified by us to all Consultants.

The Hermitage Medical Clinic's [broken link removed]also states that VHI fully cover out-patient PET-CT scans, though it's entirely possible that both sources are out of date.

Where did you read/hear that VHI no longer offer direct payment for PET-CT scans?​


----------



## olddog

Thank you all for your replies.

I'm totally bemused by the web of rules that seem to exist and the lack a clarity that seems to exist as to what rule applies in what case.

From my experience with the call centre it would seem that the best way to deal with the VHI in unclear situations is by letter ( or am I being over cautious ? )

Any suggestions as the the phrasing of such a letter ?


(FWIW plan is Co plan Exec)


----------



## pj111

The plan is irrelevant in terms of outpatient cover for scans.


----------

