# Invalid health insurance & large hospital bill.



## Emiso (21 Jun 2010)

Deleted for reason below


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## tenchi-fan (21 Jun 2010)

You have a point. She certainly didn't enter into the contract. Get a solicitor to write a letter forcing this point.
She should also get the solicitor to scrutinise the T&Cs to see the insurance company's definition of "resident"


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## mathepac (21 Jun 2010)

Anything helpful / useful [broken link removed]


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## Ravima (21 Jun 2010)

Who put her in? If involuntary, then perhaps she should contact a solicitor as she might not be liable for the cost, but whoever put her in might be?


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## Emiso (21 Jun 2010)

Thanks for all the replies. Her GP dealt with the involuntary admission


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## csirl (22 Jun 2010)

Emiso said:


> Thanks for all the replies. Her GP dealt with the involuntary admission


 
Any reason why the GP admitted her as a private patient instead of a public one?


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## NovaFlare77 (22 Jun 2010)

Emiso said:


> Surely the hospital had a duty to check out her insurance to ensure that it was valid in view of the fact that she was not in a position to do it herself.?


 
I know that BUPA and VHI had procedures in place with the private psychiatric hospitals that admissions needed to be pre-approved so that the hospital could be certain it was covered. I presume this is still the case. I'm not sure if Aviva do the same, but I'd be inclined to think that they do. That said, given that this was probably an emergency admission as opposed to a planned admission, the hospital may not have had time to check coverage.

It is curious (for want of a better word) that she was referred to a private hospital instead of a public one. There was a report last week that showed that out of the 1400 people that were involuntarily admitted to psychiatric hospitals, only 86 of them were to private psychiatric hospitals. The GP no doubt had the patient's best interests at heart, but did he/she admit to a private facility simply because he/she thought your relative would be covered?

All three health insurers do have terms stating that the coverage is only for people living in Ireland, and they usually specifiy the number of days per year that someone must be living in Ireland (I think it's 180 per year). However, check to see if this is per calendar year or per policy year and then see if how your relative's time abroad fits in. Could it be the case that while she might have been abroad for more than 180 days overall, but that it's split across the insurer's definition of year?

Other than that, you are down to the fact that she received a service to which she neither requested or consented to, but my contract law knowledge is absolutely zero, so there may be exceptions in the case of health services, etc.


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## pinkyBear (22 Jun 2010)

I am not sure of the practice in Psychiatric hospitals, but all private hospitals check a patients Health Insurance status with the company, as do public hospitals. I would see the hospital admissions have erred here, as it is their role to confirm the persons status and to act accordingly.


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## dymo (22 Jun 2010)

I know that if you are admitted to a public hospital under a involuntray form you are not libale for the bill. dont know if this is any good to you


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## csirl (22 Jun 2010)

Is your relative an EU National? Non-resident, non-EU nationals have no rights to public health care. Could it be that your relative is from overseas, albeit someone who has lived in Ireland for most of the past few years, and by spending too long away lost residency status?


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## annet (22 Jun 2010)

Was the approved centre that your relative was admitted to a private or public facility?  If it was a private facility, your relative was not of legal sound and mind to enter into any kind of contract.  

If it is a public approved centre that is now issuing the bill, the person would have recourse to dispute the private admission to a public facility billing to the Office of the Ombudsman.  

There is more than the GP involved here in the involuntary admission.  The clinical director of the hospital is informed by the GP of an order for an involuntary admission, and there would also have been a mental health tribunal held to review the persons detention order. 

If it was a private facility, I would also be asking serious questions about the responsibility of that facility and their financial management systems if they allow patient bills of 60,000 or so to encrue, without establishing if that person actually has valid insurance to cover it.

The other question I'd be asking is whether your relative was paying for private health cover?  If the person was paying for insurance, I would contact the financial regulator to establish what exactly the position is on cover if you pay for PHI and you are non-resident.

It maybe, also a good idea to contact a MH advocacy group that would be able to throw some light on the matter.  SHINE may be able to help with advice.


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## mathepac (22 Jun 2010)

annet said:


> ...  The clinical director of the hospital is informed by the GP of an order for an involuntary admission ...


The referring GP, after examining the patient, can only recommend that an involuntary admission order be made. A consultant psychiatrist on the staff of the receiving hospital makes the order for involuntary admission, if an order is deemed necessary and appropriate after examination. The consultant psychiatrist making the order does not have to be the clinical director of the receiving hospital.


annet said:


> ...  and there  would also have been a mental health tribunal held to review the persons  detention order...


Correct. All new orders and applications for the extension of existing orders must be reviewed by a mental health tribunal appointed by the Mental Health Commission.

[broken link removed]


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## Emiso (22 Jun 2010)

Thank you all so much for the very helpful replies. She was admitted to a private facility because she had health insurance in place as most policies cover this. Think it was only when it was discovered that she hadn't been resident here for the past year that the policy became invalid.
I will pass the information to my relative and their immediate family. They had just accepted the situation and resigned themselves to remortgaging to pay the bill.

Mathepac, I'm open to correction on this but I was under the impression that a member of staff in the receiving mental health facility cannot make an order for involuntary admission. I have a friend with a mental illness and when she gets a psychotic episode and becomes a danger to herself /refuses admission, her consultant psychiatrist cannot make the order and it is the GP who has to do so.However once this is in place, the consultant can then direct the care.


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## mathepac (23 Jun 2010)

Section 9 of the Mental Health Act 2001 specifies  Persons who may apply for involuntary admission and those who may not apply.

Section 10 of the Act specifies "Where a  registered medical practitioner is satisfied following an  examination  of the person the subject of the application that the person  is  suffering from a mental disorder, he or she shall *make a   recommendation* (in this Act referred to as “a recommendation”) in a  form  specified by the Commission that the person be involuntarily admitted"

Section 14 of the  Act specifies that "... a consultant psychiatrist on the staff of the approved centre shall, as  soon as may be, carry out an examination of the person and shall  thereupon either ... "  a) make an order or b) refuse to make an order.

The person making the *recommendation* under Section 10 of the act cannot be "a member of the staff of the approved centre to which the person is to  be admitted"

So a GP makes a recommendation for an order to be made, a consultant psychiatrist at the approved centre cannot make a recommendation for an order.

A GP cannot make an order for involuntary admission, only a consultant psychiatrist at the approved centre can make an order.

It is a process that makes sense IMHO with initial observations and application for an order being made by one person, an examination, recommendation and referral being made by a medical generalist and the order being made by the medical specialist after further examination and diagnosis, with the tribunal representing the patient being included.


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## Moral Ethos (23 Jun 2010)

The hospital itself could end up footing the bill here.


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## annet (23 Jun 2010)

*Legal Representation during involuntary admission*

Purely out of interest, what would be the legal view of the responsibility of the legal representative who was appointed to represent the interests of the person under involuntary admission?


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## Brendan Burgess (24 Jun 2010)

It's a very, very difficult issue. 

It's perfectly reasonable for the VHI to exclude people from cover if they have been living abroad for over a year. 

It's perfectly reasonable for the VHI to confirm in an emergency situation that the person is covered. They are not making a  decision on a claim. They are just confirming that insurance is in place subject to all the terms and conditions of the policy.

It is perfectly reasonable for the doctor to send the woman to a private hospital instead of a public hospital as he obviously expected that she would get better care there.

It's perfectly reasonable for the hospital to expect that their bill will be paid. 

I would have guessed that this issue would have come up before. If the person can afford it, I would expect her to pay for it. She did get the service after all, whether or not she asked for it, it would seem that she needed it. 

If the cost is excessive, I would think that a fair solution would be to split it three ways - hospital, VHI and patient. I think you should put this proposal to the VHI first before paying the bill. 

Brendan


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## Complainer (24 Jun 2010)

Brendan Burgess said:


> It is perfectly reasonable for the doctor to send the woman to a private hospital instead of a public hospital as he obviously expected that she would get better care there.


If you mean better medical care, this is absolutely outrageous. Quality of medical care should not be based on your wealth or your insurance.


Brendan Burgess said:


> It's perfectly reasonable for the hospital to expect that their bill will be paid.


I don't think it is that simple. Given the very particular circumstances of this case (involuntary detention), it is up to hospital to make sure that the person either has insurance or has lots of moolah. They should really have made certain of this in the first week or two, before huge bills had been run up.


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## csirl (24 Jun 2010)

I cant see how someone can be made responsible for something they did not agree to. Also, the person was mentally ill, thus was not capable of making a decision to avail of private health care. The hospital admitted her to private care at their own risk - and it was one of their staff who made the involuntary admission decision - nobody forced them to take her as a private patient, she could have been admitted somewhere as a public one. I think the hospital has to write this one off to experience.


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## Brendan Burgess (24 Jun 2010)

csirl said:


> I cant see how someone can be made responsible for something they did not agree to. Also, the person was mentally ill, thus was not capable of making a decision to avail of private health care. The hospital admitted her to private care at their own risk - and it was one of their staff who made the involuntary admission decision - nobody forced them to take her as a private patient, she could have been admitted somewhere as a public one. I think the hospital has to write this one off to experience.



There is a practical issue here. The private hospitals will have to simply refuse to take emergency cases. They can't wait for the VHI to check the claim before admitting the patient. That is why I suggested splitting it three ways if the person can't afford it.


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## Towger (24 Jun 2010)

+1 csirl. 60K is nothing in costs of the running of a hospital, but could take 10 years+ for the average family to replay.


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## Complainer (24 Jun 2010)

Brendan Burgess said:


> There is a practical issue here. The private hospitals will have to simply refuse to take emergency cases. They can't wait for the VHI to check the claim before admitting the patient. That is why I suggested splitting it three ways if the person can't afford it.


They can get around this practical problem by ensuring that cover is in place very quickly, over a few days - before large bills have been run up. Coming up with a €60k bill after three months is very unprofessional practice by the hospital.


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## redbhoy (24 Jun 2010)

Why is the policy cancelled if you dont live in Ireland? 
I thought one of the EU Treaties covered this kind of thing?
Was it the Nice Treaty that said we could go to Holland buy a car, drive to France for Insurance and take the Ferry back to Ireland?


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## Towger (24 Jun 2010)

I believe, the VHI have limit of 180 days out of the country for cover, unless you take out one of the extra travel options. I am making the assumption that the person is young and travelling or a student abroad and the condition may have started while away. The insurance company have 'learned' this and are now not covering the bill. I know St. James often have young 'foreign nationals' admitted, who want of a better word have lost it. They take them in, try and findout who they are and to contact the parents to bring them home.


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## Moral Ethos (24 Jun 2010)

Towger said:


> +1 csirl. 60K is nothing in costs of the running of a hospital, but could take 10 years+ for the average family to replay.





Complainer said:


> They can get around this practical problem by ensuring that cover is in place very quickly, over a few days - before large bills have been run up. Coming up with a €60k bill after three months is very unprofessional practice by the hospital.


I agree with you both.

If the hospital push the issue and it goes to court, they will be on very shaky ground and in all probability loose.


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## Emiso (25 Jun 2010)

Thanks for all the further replies. The VHI has been mentioned several times and I wish to   State that this is not the company in question.


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## Moral Ethos (25 Jun 2010)

The advice given still stands.


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## Towger (25 Jun 2010)

The question arises, is it the persons own policy or on their parents etc?


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## Emiso (26 Jun 2010)

Hi all, thanks for all the replies. I think that i will delete the details of my OP as I have passed all the information on.

Kind regards


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