# Legal position re: hospital bill



## pistolpete (31 Jan 2012)

Hello,
I have a general query in relation to the legal position relating to a hospital bill which the VHI did not refund in full. 

The facts are as follows:
1. I was admitted to a public hospital as an emergency. While there I was seen by a consultant from a private hospital who also had a position as consultant in the public hospital.

2. The consultant arranged for me to have a procedure in the private hospital where he worked as it could not be carried out in the public hospital. I was told by another doctor in the public hospital that as I had VHI cover it would not cost me anything. I was not given any other option and was told the procedure was absolutely necessary (potentially life or death).

3. I was transferred to the private hospital and signed an admission form agreeing that if the VHI did not cover the full cost then I would be personally liable for the balance. The procedure to be carried out and the relevant cost were not detailed anywhere on the form. It subsequently transpired that they had me down for the wrong VHI cover even though they had the correct VHI number. In addition there was a box for "cover confirmed" which had been left blank.

4. After the procedure was performed I was informed by the hospital that my VHI cover would only pay for 50% of the cost. This came to almost €4,000. In addition the consultant received a fee of over €1,000 for the procedure.

5. I subsequently learned the procedure could have been carried out in another public hospital (albeit 50 miles away) at no cost to myself

Have I any case for not paying this? They insist they will pursue me through the courts if necessary to recover the sum in question.


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## asdfg (1 Feb 2012)

speak directly to v.h.i about this it all depends  what level your covered under.also phone irish patients association ,there very helpfull.Solved a problem i had with a hospital in the past .Good luck


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## pistolpete (2 Feb 2012)

asdfg,
Thanks very much for that. I had never heard of the Irish Patients Association. I will give them a call.


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## csirl (2 Feb 2012)

I had a similar experience one time - VHI wrote saying they would not cover the private bill. I checked my policy and the private hospital was listed. I rang them, explained the situation and they paid the bill immediately. The reason they didnt pay on receipt of the paperwork from the hospital is because usually you need to be referred to a private hospital by a GP etc. for a procedure and there was no referral in the paperwork they received, so their staff processed it incorrectly due to the confusion/unusual circumstances (though maybe not if OP was in similar situation). The 'referral' by the consultant with his public hospital hat on was sufficient to be covered so they paid immediately.


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## argentina (2 Feb 2012)

I had a (sort of) similar experience.  I have a small baby and recently we spent 12 hours in A&E in a Childrens Hospital and the baby was admitted for a week.  During the admission process we were asked to sign a form so the Hospital could claim from our Health Insurance.  Looking back they were quite manipulative about this, almost like they had someone nearly professionally trained to get the signature on the form.  My baby was 'classified' as a private patient, which in reality made no difference to the next child as there really is no such thing as private in a childrens hospital.  What is annoying about it is now that the Child has discharged, all the follow up appointments incur heafty fees.  We have been back to the hospital on a few occasions with different doctors and other health care professinals and have had to pay substantial fees.  
If we had kept our health insurance details to ourselves upon admission these Appointments with the same Doctors would cost us nothing.  When I queried it with the Hospital I was told that because I have Health Insurance we have to use it, the line they use makes it sound like our Health Insurance covers out-patients fees.


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## Time (2 Feb 2012)

You are under no obligation to use insurance.


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## pistolpete (3 Feb 2012)

Thanks for the replies above. 

The problem I have is not with the VHI paying the bill. As I said above my primary issue is with the fact that there seems to be a conflict of interest on the consultants part in referring me to a private hospital of which he was an employee. As a result I could be out of pocket for €4,000 which, if the facts had been made known to me, I would definitely have refused to be treated in the private hospital. 
As a point of law do I have a case in refusing to pay this balance?


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## scuby (4 Feb 2012)

if admitted to a public hospital and they cannot do the test/procedure for what ever reason, and they move you somewhere else to have it, they should be settling the cost with the private hospital, as it was their fault for transferring you. also, they should not have made you transfer as a private patient to the Dr wokring in the private hospital.
i would contact both hospitals and complain.


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## pistolpete (5 Feb 2012)

Thanks again for the replies but I was hoping for a legal opinion on whether I would have a winnable case. Should I just pay up or is it worth my while to fight this through the courts?

That is why I originally posted this on the legal forum as it is not really a query on health insurance.


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## scuby (6 Feb 2012)

well i wouldn't be going down the legal route yet, speak to the hospitals first and see where you stand


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## amgd28 (6 Feb 2012)

argentina said:


> I had a (sort of) similar experience.  I have a small baby and recently we spent 12 hours in A&E in a Childrens Hospital and the baby was admitted for a week.  During the admission process we were asked to sign a form so the Hospital could claim from our Health Insurance.  Looking back they were quite manipulative about this, almost like they had someone nearly professionally trained to get the signature on the form..........
> If we had kept our health insurance details to ourselves upon admission these Appointments with the same Doctors would cost us nothing.



The fact is that the hospital in question is hugely reliant on income from the insurers to keep wards and hospital open. I believe that the only reason watds stayed open in one Dublin paediatric hospital last year was due to a new approach to maximise income. This year hospitals are being penalised in their funding if they don't maximise their income, so this approach is essential to ensure that all our kids have a service that can be relied on in the face of funding shortages.

I'm not having a go here, but I would be the first to complain (as the C&AG annually does), if the hospitals were letting this potential income be missed by lack of attention while at the same time closing wards due to lack of funds.

I think if you're in the pleasant position of affording health insurance and your child actually gets sick, and is subsequently treated and sorted out, then few outpatient fees are a small cost to pay. Note also that the hospital gets no income from the consultant outpatient fees - all go to the doctor.


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## pistolpete (7 Feb 2012)

scuby said:


> well i wouldn't be going down the legal route yet, speak to the hospitals first and see where you stand



Unfortunately it already has gone down the legal route (on their side).

I'm just wondering if I should pay up or is it worth my while to defend (thereby incurring extra legal costs)?


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## sean.c (10 Feb 2012)

Look at it this way;
Where is it documented that you were told that the procedure could not be carried out in a private hospital?
When you arrived at the private hospital, were you aware of what you were signing at the time you signed it (i.e. liable for all costs that insurance won't cover)?

In short, I don't think you have a leg to stand on, unfortunately. Of course, a good solicitor/barrister can argue the point about anything, but how much will that cost you?

It seems to me your main grievance is the behaviour of the consultant. You may consider making a complaint to the Medical Council to achieve satisfaction on that score.
I'm not a lawyer, mind you


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## pj111 (13 Feb 2012)

pistolpete said:


> I was told by another doctor in the public hospital that as I had VHI cover it would not cost me anything.


 
Unfortunately, too many people take a doctor or secretary's word or even a poster on a site like this. In all instances a claimant should check with their insurer in advance of treatment.

_Here's 9 reasons why cover might not pay out for an individual_ :

(1) wrong hospital (2) wrong plan or wrong plan on card (3) wrong procedure code (4) unpaid premium by an individual or company (5) not a medically necessary procedure (6) not eligible due to break in cover (7) upgrade waiting period (8) consultant not covered (9) wrong insurer

Write to both the hospital and VHI to put them on notice that you are disputing the bill before it goes legal AND it can be good to talk.

_Patrick_


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## confusedanda (22 Apr 2012)

*quinn and no beacon*

I switched from vhi to quinn 3 yrs ago after 20 yrs with vhi,  
as they got too expensive.
I asked for a price for a similar plan with the same level of cover,I can't exactly remember what I was quoted at the time but last year's renewal was €780
Everything seemed fine until this week my gp referred me to the beacon and now I find out that quinn don't cover the beacon
Any advice


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## Padraigb (22 Apr 2012)

You might ask your GP to refer you somewhere else.


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## huskerdu (22 Apr 2012)

Padraigb said:


> You might ask your GP to refer you somewhere else.



I would insist that my GP refer me to a consultant who works in a hospital that you are covered for. 

Maybe your GP was just lazy and refered to his mate, who is always refers to without thinking it through, but you are the patient and the consumer and you have no obligation to attend the private consultant that your GP choses.


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## NovaFlare77 (23 Apr 2012)

confusedanda said:


> I switched from vhi to quinn 3 yrs ago after 20 yrs with vhi,
> as they got too expensive.
> I asked for a price for a similar plan with the same level of cover,I can't exactly remember what I was quoted at the time but last year's renewal was €780
> Everything seemed fine until this week my gp referred me to the beacon and now I find out that quinn don't cover the beacon
> Any advice



May I ask what your GP referred you to the Beacon for? i.e. was it a consultant's appointment or a lab test or a scan or the like?


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## interp (27 Apr 2012)

OP, there was an interesting court case relating to a patient who was billed €4,000 for being a private patient in Beaumont Hospital on irish health dot com Apr 26th. The findings of the court in that instance may be of interest to you.

Sorry, but I can't post the url link.


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