Health Insurance Claiming Outpatient expenses in ambulance call out

L

Look ahead

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I had to call an ambulance for my brother few weeks ago, he wasn't admitted, thankfully and left A&E later after getting the all clear. . He has Laya policy. He got a bill for €100 for the am bulance callout from the hospital and Laya are refusing to treat it as outpatient expense. They saying that the HSE ambulance service should have asked my brother if he had health insurance and then they would have had to preauthorize it with Laya before ambulance was dispatched. I never heard such crap.....what should be done here?
 
Where in his policy does it state that he's covered for Ambulance call out charges? It certainly doesn't mention them in my policy.
 
Is the 100 euro not the standard A&E charge, rather than a "transport" charge for the ambulance?
 
Is there some confusion that Laya thought it was an ambulance transport rather than an emergency callout to bring someone to A&E?

Can you resubmit it under the category of A&E?
 
As a public patient there should be no charge for you calling an ambulance who takes him to a public A&E. The normal €100 A&E bill applies.

Some private insurance policies will pay this or a portion of it, some don’t.

If you asked a private ambulance service to transport him then you would need to get that cleared with your health insurance first to see if it was covered, but I think they are more than €100.

There is some confusion going on here. Can you clarify everything again?
 
odyssey06 said:
Is there some confusion that Laya thought it was an ambulance transport rather than an emergency callout to bring someone to A&E?

Can you resubmit it under the category of A&E?
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Yes, he submitted the claim as an out patient expense and received €50 back under his laya connect simplicity policy. This is despite two customer service reps telling him he wasnt covered. They not very well advised.
 
Look ahead said:
Yes, he submitted the claim as an out patient expense and received €50 back under his laya connect simplicity policy. This is despite two customer service reps telling him he wasnt covered. They not very well advised.
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I have had similar experience with some scans.
 
gipimann said:
Is the 100 euro not the standard A&E charge, rather than a "transport" charge for the ambulance?
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I think that is correct.

AFAIK you can only avoid that €100 charge if you have a referral letter from your GP. That is not always possible in the OP's situation where it was urgent.
 
The LAYA connect simplicity product specifies for the Hospital Casualty Charge a benefit of 50% up to €50 per visit so it seems to be right.

OP's brother should claim tax relief on €50 as an unrecovered medical expense. i.e. expense was €100 but only €50 recovered so balance of €50 is unrecovered.
 
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