# Quickest way to get an operation with no cover



## seanie08 (9 Jul 2014)

Im self employed, I have basic VHI cover. I have been out of work for 4 weeks and urgently need a back operation. 
I have my MRI scan completed and paid for, I have seen the surgeon and paid him, for the consultation, he booked me in for surgery straight away in a private hospital,and then I found out my VHI covers nothing only a small refund for both expenses so far.
So do I now go to a public hospital and get put on a waiting list for months or try somehow to pay for the surgery myself?
Im in serious pain and need to get it sorted.


----------



## Time (9 Jul 2014)

Forget about a public waiting list, you could be years waiting.

The only way forward is to show up with a few tesco bags full of cash. Sad but true.


----------



## aoc (9 Jul 2014)

If you have the operation code - call VHI and see where do they cover  - most surgeons operate in several hospitals, it may be covered in one of them..... been there, do not envy you! best of luck....


----------



## AlbacoreA (9 Jul 2014)

How come VHI don't cover it?  I had a long debate one day with them trying to find out what operations they cover, they didn't have a specific list to offer. Just replied with the routine operations, in certain area's. Is their actually a list of which plans cover which operations?


----------



## seanie08 (9 Jul 2014)

Thanks everyone it looks like the credit union will be getting a call.
You get a procedure code to check with your health insurer, and this tells them what sort of operation it is. I had a look at my cover and it is very vague as too what exactly they do cover.
I had too pay €200 for scan and get €40 back, one Consultant fee for 10min cost €280 and I get €60 back.


----------



## Jim2007 (9 Jul 2014)

seanie08 said:


> Thanks everyone it looks like the credit union will be getting a call.
> You get a procedure code to check with your health insurer, and this tells them what sort of operation it is. I had a look at my cover and it is very vague as too what exactly they do cover.
> I had too pay €200 for scan and get €40 back, one Consultant fee for 10min cost €280 and I get €60 back.



So what have you got to loose exactly by trying to go public???  Until you actually try, you have no idea how long the wait be...  If it works you've saved a bit, if not you can still go private.


----------



## AlbacoreA (9 Jul 2014)

seanie08 said:


> Thanks everyone it looks like the credit union will be getting a call.
> You get a procedure code to check with your health insurer, and this tells them what sort of operation it is. I had a look at my cover and it is very vague as too what exactly they do cover.
> I had too pay €200 for scan and get €40 back, one Consultant fee for 10min cost €280 and I get €60 back.



The charges for scans and Consultants is to be expected on some plans. 

But you said it didn't cover the operation. Have you checked that specifically?


----------



## Protocol (10 Jul 2014)

Time said:


> Forget about a public waiting list, you could be years waiting.
> 
> The only way forward is to show up with a few tesco bags full of cash. Sad but true.



*Years *may be an exaggeration.

Months, maybe.

Maybe weeks, it's hard to know.

Note that thousands of people get treated each day in the public system.


----------



## laois1 (10 Jul 2014)

Hi. Your VHI probably covers this operation, just not in certain private hospitals, possibly black rock clinic, mater private etc. it will likely cover for you in a semi private or private bed in a public hospital. The waiting list for this may not be as long as you think as you are still a private patient. Ring your consultants secretary and ask which other hospitals they work in then call their private secretary in that hospital and ask about the waiting list. I would expect several years wait if you were a public patient but not with semi/private insurance.


----------



## laois1 (10 Jul 2014)

Ps. Check your plan details on hia.ie. it will tell you the level of in patient cover you have.


----------



## seanie08 (10 Jul 2014)

Thanks everyone, I checked with VHI and the operation is not covered. I checked with surgeons private secretary and was told that if I was marked as a priority case it would still be months, but no exact time.
And as I have been laying on my back for a month waiting for things to happen, in pain , I guess I may pay up.
Just for anyone else that happens to be paying insurance, i have paid this for 25 years, no claims, so just find out EXACTLY what you are covered for.
On the bright side by Monday evening I will have operation over and on the way to recovery, Happy days.


----------



## RainyDay (10 Jul 2014)

Which VHI package are you on?


----------



## Jim2007 (10 Jul 2014)

seanie08 said:


> I checked with surgeons private secretary and was told that if I was marked as a priority case it would still be months, but no exact time.



Well it's not the way I would approach it... the surgeon's private secretary is not  the public service... and I would be sure how motivated she be to get you fast tracked on the public service, if you're a potential fee payer!  What does your GP say to all of this I wonder?


----------



## AlbacoreA (10 Jul 2014)

Protocol said:


> *Years *may be an exaggeration.
> 
> Months, maybe.
> 
> ...



In our experience months is normal even up to a year for some situations. Sometimes the public is quicker, sometimes a lot slower. Its impossible to know.


----------



## AlbacoreA (10 Jul 2014)

Jim2007 said:


> Well it's not the way I would approach it... the surgeon's private secretary is not  the public service... and I would be sure how motivated she be to get you fast tracked on the public service, if you're a potential fee payer!  What does your GP say to all of this I wonder?



I also would be wary of taking the work of secretary and even docs/consultants at face value, in particular with waiting lists. We were once delayed months because a secretary couldn't/wouldn't send a fax until I said I'd hand deliver the fax.


----------



## AlbacoreA (10 Jul 2014)

Jim2007 said:


> Well it's not the way I would approach it... the surgeon's private secretary is not  the public service... and I would be sure how motivated she be to get you fast tracked on the public service, if you're a potential fee payer!  What does your GP say to all of this I wonder?



I'd also add that even if you go public, but have insurance they'll find a way to charge your insurance or you directly. I had 2 yrs of arguing that a specific treatment was done on the public system, only for them to charge the insurance anyway. They changed their reason for doing this about a dozen times. I gave up arguing, because the insurer had no interest in avoiding charges.


----------



## AlbacoreA (10 Jul 2014)

seanie08 said:


> ...Just for anyone else that happens to be paying insurance, i have paid this for 25 years, no claims, so just find out EXACTLY what you are covered for.....



its very hard to get a list of specific treatments that are included as the policies aren't very specific.  As a result its very hard to argue when they say a treatment isn't included.


----------



## laois1 (10 Jul 2014)

I'd agree with the above. Don't take secretaries word for it. What is the procedure or code ? It must be something hi tech or new or specialised? There may be an old fashioned or alternative procedure available which would be covered. The majority of inpatient procedures are covered on all plans. Without knowing specifics it's hard to comment further.


----------



## wbbs (10 Jul 2014)

Well isn't that just depressing, you pay for years and then you haven't cover for the thing you need.  How can any of us know what possible treatment we are going to need, it would be impossible to go through the policies to see what is not covered if we don't know what illness we will get or procedure we will need.   Makes you really wonder about the point of it all.


----------



## Time (10 Jul 2014)

AlbacoreA said:


> In our experience months is normal even up to a year for some situations. Sometimes the public is quicker, sometimes a lot slower. Its impossible to know.



Absolutely, I was quoted 2-3 years for a dental operation on the public system. Going private i.e. a large amount of cash, it was done the following week.


----------



## glynner (10 Jul 2014)

I have a friend that needed an operation and her health insurance did not fully cover Blackrock Clinic. She was told to phone them anyway and when she said her health insurance  did not fully cover the cost they told her don't worry and  they waved the difference. I believe its worth a try.


----------



## AlbacoreA (10 Jul 2014)

+1 always worth trying. 



wbbs said:


> Well isn't that just depressing, you pay for years and then you haven't cover for the thing you need.  How can any of us know what possible treatment we are going to need, it would be impossible to go through the policies to see what is not covered if we don't know what illness we will get or procedure we will need.   Makes you really wonder about the point of it all.



Another experience was to be entitled to private room, not getting it, getting MRSA, then getting an isolation room. The person sadly passing away (MRSA). Then being charged as a private patient. 

It obviously not always that bad. Sometime it works out well. But for me I think the system is very broken.


----------



## RainyDay (10 Jul 2014)

laois1 said:


> Hi. Your VHI probably covers this operation, just not in certain private hospitals, possibly black rock clinic, mater private etc. it will likely cover for you in a semi private or private bed in a public hospital. The waiting list for this may not be as long as you think as you are still a private patient. Ring your consultants secretary and ask which other hospitals they work in then call their private secretary in that hospital and ask about the waiting list. I would expect several years wait if you were a public patient but not with semi/private insurance.



I think you're right on this. Doesn't the most basic level of private health insurance provide basic cover for all conditions in semi-private beds in public hospitals?


----------



## Butter (12 Jul 2014)

I wouldn't be so quick to offer to pay for it yourself. A back operation could run to thousands very quickly. Have you had a quote? You need to make sure you factor in all the costs - private bed per day, x-rays, scans, theatre staff, consultant surgeon, consultant anaesthetist etc etc. 
Double check that a similar operation is not covered by your insurance. Ask your consultant is there something else that can be done with a code that is covered under your insurance? He/she may be able to do something if they are aware that that particular procedure is not covered. In short - fight for the right to use your insurance.


----------



## laois1 (12 Jul 2014)

Agree with the above. There is likely an alternative procedure which should be offered to this patient which is covered. Advise researching the various operations possible for this condition. Ask the consultant about alternatives. As pointed out the costs old very quickly escalate particularly if complications arise and a longer admission is required. A relative recently had a fairly uncomplicated cardiac procedure done in the beacon, a day case. Price over 7 k. Lucky insurance picked up the tab.


----------



## Branz (12 Jul 2014)

Just to say that in post 10, dated 10th July, the OP says: by Monday job will be done.


----------



## seanie08 (13 Jul 2014)

The only info I can get is off people on here, so Thankyou. I have contacted hospital depts. but just getting no help. I cannot get any help from the hospital im going too. I can get a bed in another hospital from VHI but put on the waiting list for operation, and they wont/cant give me any indication when that will be.
I am self employed, i have been flat on my back in pain for a month, my 4 staff had to stay at home. I am due in too pay for operation in the morning, Desperation has set in.


----------



## arbitron (13 Jul 2014)

seanie08, I'm sorry to hear about the hassle you've had. If you can hold off even a week more that may give you enough time to make sure you've exhausted all the options. 

Some health insurance plans are very restrictive - can you tell us which plan you're on?

What is the procedure code?


----------



## valery (13 Jul 2014)

Seanie08,  is your operation done in Public Hospitals?  Last month there was a posting about Aviva not covering treatment for Melanoma that was covered for public patients.
When you take out private health insurance, at the very least, you expect to be covered for all treatment available in the public system.
If this is not the case and insurers are opting out providing certain cover, this need to be highlighted and the HIA surely have a role here.
It's just not good enough to provide a comparison chart unless the treatment provided is similar.


----------



## seanie08 (16 Jul 2014)

Hi everyone im back, operation over pain gone. I had VHI first level plan one, procedure code 5728,double micro lumbar discectomy.
My surgeon and his team were the most professional group I have ever met. Now I have a small hole in my back a big hole in my bank balance. Cost= ONE night stay in hospital € 3250.00, Surgeon = €2000.00, Anesthetic =€ 700.00est. OUCH!!!!!!!!
But here is where im looking for advice???
I would describe my one night stay in hospital as disgraceful, a third world hospital managed by Basil Fawlty.
Just a quick idea, is that I filled in 5 different reports with different members of staff including a kitchen menu saying that I was lactose intolerant, everything I got on the first day was dairy based, We had travellers lamping rabbits in the hospital grounds at night, shinning there spot lights into the rooms, you couldn't make these things up.
There is a long list to go with these, then I was discharged, said goodbye to everyone and arranged a lift 60miles home.
When I got home I got a call to come back to the hospital, as they hadn't changed my dressing and needed to take the needle out of my arm that they fed the drips through.
A heated debate took place in which they told me to go to my GP and get him to do it.
I am livid! I intend to write to the hospital outlining the things I found wrong.
Is this the best way to approach it or is there some other way of going about it?


----------



## arbitron (16 Jul 2014)

Good to hear you have it over you.

There should be a designated complaints officer, usually within the patient safety/quality department, that you could write to. Best to email them so you have a trail & do it ASAP so it's still fresh.

If you aren't happy with the response you could also contact a patient advocacy group. If you need to escalate further you could consider writing to JCI which accredits all private hospitals in Ireland.


----------

