# Mater Private & Blackrock are effectively applying a discount by waiving shortfalls.



## macdo (28 Aug 2013)

*Mod Edit: This interesting discussion was split from this thread*  1A(F) Laya Health Manager Starter Renewal  €1,241 01/10/13 aj


Be aware she will have upgrade waiting periods for increase in inpatient cover over existing policy. You don't mention what her usage for day to day cover is. Location is also very important too. 

If high tech hospitals are important, Laya has poor cover for some of the big ticket operations in these hospitals.


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## snowyb (28 Aug 2013)

So, what are some of the 'big ticket operations in these hospitals'?

Snowyb


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## macdo (6 Sep 2013)

All the "special procedures" that Vhi, Aviva and Glo have. Laya don't have any special procedures. 

This means that all of their plans that have nightly shortfalls for Blackrock Clinic, the Mater Private and the Beacon Clinic have a shortfall per night for all the procedures that other companies cover with no excess or a small one off excess.


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## snowyb (9 Sep 2013)

Aviva and Glohealth have a 2000 co-payment for these special procedures, while VHI have 80% cover restriction also. 

The actual reality of this is a different story altogether.  Since 2008, the two hi-tech hospitals Mater Private and Blackrock Clinic are not collecting shortfalls for a wide range of surgery - including the special procedures surgery list. 
These waivers apply to all providers including Laya.

I have no experience of the Beacon Hospital, so I'm not sure if they are collecting shortfalls for special procedures. I would assume they are, but this is subject to clarification.

Aviva and Glohealth also apply a 2000 co-payment for orthopaedic surgery in private hospitals on most plans,  VHI cover 80% of the cost of this type of surgery again on the majority of mid-range plans in private hospitals.  
Laya fully cover this type of surgery in private hospitals.

Snowyb


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## pj111 (10 Sep 2013)

snowyb said:


> Since 2008, the two hi-tech hospitals Mater Private and Blackrock Clinic are not collecting shortfalls for a wide range of surgery - including the special procedures surgery list. These waivers apply to all providers including Laya.



I'm afraid Macdo is correct Snowyb. Laya will always have shortfalls on Special Procedures in High Tech Hospitals except on their highest levels of cover. 

Firstly you state that Aviva & GloHealth have a €2,000 shortfall and that Vhi have a 20% shortfall on Special Procedures which is largely incorrect. It also suggests to me that you don't yet understand what the term 'Special Procedure' refers to. 

There are almost 240 Special Procedures available in High Tech Hospitals. 

Of these: 

GloHealth has a €2,000 excess on only 11 of them.

Aviva Health has a €2,000 excess on 10 of them.

Vhi has a 20% shortfall on 22 of them.

Vhi's restrictions only relate to certain *Orthopaedic* *& Ophthalmic procedures only*, and only in Private & High Tech Hospitals.

Aviva and GloHealth's restrictions relate to certain *Orthopaedic procedures only* and again only in Private & High Tech Hopsitals.

Laya Healthcare however have shortfalls that relate to *all 200 plus Special Procedures in High Tech Hospitals*. I will explain this in more detail further on.


  Secondly you go on to state that the Mater Private is waiving the Aviva's & GloHealth’s €2,000 shortfall on orthopaedic procedures. I’m afraid that this is not correct either. The Mater Private do waive the Vhi shortfall of 20% on orthopaedic procedures but they certainly do not waive the Aviva shortfall.

Thirdly when mentioning the shortfalls in Private Hospitals as distinct from High Tech's you don’t make any reference at all to the fact that many of these Private Hospitals are also waiving the shortfalls, when indeed they are, and in greater numbers than the High Techs.

Fourthly you state that Laya Healthcare cover all these procedures with no shortfalls. Again this is incorrect. Laya Healthcare *do *have plans that have specific shortfalls for specific orthopaedic procedures in Private Hospitals. 

Beyond that Laya Healthcare also have general shortfalls which apply on all Special Procedures in High Tech Hospitals, which means that an additional 220 odd procedures are subject to shortfalls. The level shortfall depends on how long you spend in hospital but can range from Zero to up to €510 per night. There are also a good deal of plans with Laya Healthcare that are pitched at mid-range (to use your phrase) that have NO cover for special listed procedures in High Tech Hospitals.


  What is important here is that these things are subject to change and when it comes to Schedules of Benefits changes can happen at any time!


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## RainyDay (11 Sep 2013)

snowyb said:


> The actual reality of this is a different story altogether.  Since 2008, the two hi-tech hospitals Mater Private and Blackrock Clinic are not collecting shortfalls for a wide range of surgery - including the special procedures surgery list. These waivers apply to all providers including Laya.


Do I understand this correctly? Are you saying that Mater Private and Blackrock are effectively applying a large discount to their bills for these 'special procedures' by not collecting the shortfall?


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## snowyb (12 Sep 2013)

RainyDay said:


> Do I understand this correctly? Are you saying that Mater Private and Blackrock are effectively applying a large discount to their bills for these 'special procedures' by not collecting the shortfall?



In a nutshell yes.  Apparently since 2008.  It depends on the provider you're with, the plan you're on and the hospital in question as to what's waived or not.
I wonder how many people with health insurance in general are aware of it?

Snowyb


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## snowyb (12 Sep 2013)

pj111 said:


> I'm afraid Macdo is correct Snowyb. Laya will always have shortfalls on Special Procedures in High Tech Hospitals except on their highest levels of cover.



Hi pj111,

I never actually said in my post that Laya Healthcare do not have shortfalls for any type of procedure in hi-tech hospitals. 
What I did say is that the two hospitals Mater Private and Blackrock Clinic have a waiver system in place, whereby they are not collecting the shortfall amount per night in respect of their own individual list of surgery and procedures.

The Blackrock Clinic list is a lot broader than the waiver list with Mater Private.  Details of plans that qualify for these shortfall waivers with all 4 providers can be checked directly with each hospital.  Not all plans with all providers qualify,  and likewise some plans cover more procedures than others.

Is the 'special procedures list' the same as the Fixed Price Procedures list for example with VHI.  I have a copy of that list, which gives the procedure codes for each surgical procedure.  When a person is diagnosed, the consultant gives you the relevant code number of the surgery you require, so you can check with the accounts section of the hi-tech hospital to see if you qualify for a waiver or not.  The procedure code number is also used if querying cover with your provider.

While VHI will post out this extensive list on request, there is no information as to what procedures are covered or not on any plans. The onus is on the customer to request details from their provider as to  what procedures on this list apply to their own particular plan in a hi-tech hospital.   

The Health Insurance Authority fall very short regarding information on this Special Procedure list.  According to them,  Special Procedures means hip, knee and shoulder replacement surgery - a very limited description.

Thanks for sharing such detailed insider information in relation to the 'special procedures list.'   Your post will be of interest  for readers with all four providers. It raises more intriguing questions- such as what private hospitals are waiving co-payments or shortfalls or more importantly what private hospitals are still collecting them.

Regards Snowyb


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## pj111 (13 Sep 2013)

Hi Snowyb,

You are correct, you did not say that Laya Healthcare do not have shortfalls in High Tech Hospitals in the post in question. However I did not purport that you did! What I took issue with was you stating that Laya Healthcare dont have orthopaedic shortfalls in *Private* Hospitals. Which you said here:

_"Aviva and Glohealth also apply a 2000 co-payment for orthopaedic surgery in private hospitals on most plans, VHI cover 80% of the cost of this type of surgery again on the majority of mid-range plans in private hospitals. 
Laya fully cover this type of surgery in private hospitals"._

Laya Healthcare now have a specific orthopaedic shortfalls on their two newest plans (Essential Value & Essential 500) just like the other insurers do.


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## RainyDay (13 Sep 2013)

snowyb said:


> In a nutshell yes.  Apparently since 2008.  It depends on the provider you're with, the plan you're on and the hospital in question as to what's waived or not.
> I wonder how many people with health insurance in general are aware of it?
> 
> Snowyb



Seems bizarre to me as an outsider, and possibly anti-competitive if they charge different prices to  different customers for the same service.


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## pj111 (13 Sep 2013)

This caused ripples in the US when Medicare took issue with Hospitals waiving shortfalls.


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## macdo (15 Sep 2013)

There are lots of procedures that can be given discounts or excesses waived by private or hi tech hospitals so not major deal.

The thread should be called " Laya do not have Special Procedure Lists" or a new one set up.

Here is Glo's list of Special Procedures [broken link removed]

Laya will charge a *nightly *excess in hi tech hospitals on most of their plans but other companies will have a small *one off* excess of € 50 - €100 for these procedures.If your Laya plan had a nightly excess for hi tech hospitals and stayed in 10 nights you would have to pay €1,750 . 
This is far more important point to consider when choosing cover. Don't be fooled into making mistake in return for some refunds for doctor visits. You also need to be aware of potential upgrade waiting periods if you switch from Laya for these special procedures


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## macdo (15 Sep 2013)

snowyb said:


> Hi pj111,
> 
> 
> Is the 'special procedures list' the same as the Fixed Price Procedures list?
> ...


 
No. Fixed Price Procedures are usually for specified major complex procedures (eg neurosurgery and cardiac procedures).

Be careful taking advice about changing insurers, could be an expensive innocent mistake without going into greater detail.


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