Discrimination on Pricing-Health Ins Procedure

I am to have surgery in the Mater private hospital which will hopefully be covered under my Vivas health insurance.

I am thinking of having another procedure done at the same time which I would have to pay for. If I was going to have the two operations and had was paying directly for both, the second procedure would be be charged at the half of the price of having the operations done separately.

The fact the Vivas are paying for the first procedure I have been told that the second procedure will be charged at the full normal rate.

The justification for discrimination on price is purely because a health insurer is responsible for part of the cost.

Anybody have any ideas about this practice and if there is anything that I can pursue on the price discrimination issue?

Perhaps you should tell this to Vivas. I know from past experience for elective procedures when I didn't get the private accommodation because it wasn't available, I made sure to notify VHI and the hospital accounts. I was going to be charged for same and wouldn't have know about it as the VHI would have paid the hospital directly. Also when a child was admitted through A/E without us , she said we were in VHI and again I checked , they had her down as a private patient despite the fact she was not seen as a private patient or in private accommodation.
At the end of the day, its not the private insurers that pay the bill, its us in increased premiums.

My difficulty is that it is me who will be out of pocket for the additional amount. The Vivas bill will not change. They will cover one procedure only and will pay the agreed fee for this.I will have to pay the full fee for the second procedure but if I and not Vivas were paying for the second procedure I would only pay €3000 instead of €6000 because of the savings of having the two done together. Thks

Moved from Askaboutlaw to Insurance where you will find similar issues have been discussed in the past.

Madilla said:

I am to have surgery in the Mater private hospital which will hopefully be covered under my Vivas health insurance. I am thinking of having another procedure done at the same time which I would have to pay for.

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why can't both procedure be done together and be paid for by vivas ?

Madilla said:

Can I pursue ..... discrimination issue?

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I cant see any grounds on which you can claim discrimination.

The way I see it the Health Insurer (Vivas) has negotiated a schedule of prices with the Healthcare Provider (the Hospital) for a list of specified procedures.

Individuals are, of course, free to negotiate with the Healthcare Provider separately and may be able to get discounts or a deal along the lines "get one operation get one for half price".

What you cant do is cherry pick the bits of each package that appeal to you.

Sorry , I think I misunderstood your post.

No problem Brianne.
I wouldn't have thought I was cherry picking. I would have just expected that the cost saving in terms of having the two procedures carried out together would be at least partially passed on to me. If I want to have the second procedure done at another time I would pay the same as having it done when I am already in theatre which seems rather unfair. It is the fact that were Vivas not paying that the procedure would be half price that I feel is unjustified.

Just a thought, could you organise it that you could pay for the first procedure directly yourself and then claim from Vivas , it might be worth it to talk to Vivas, to a manager and see how much they would pay you for the first procedure or if they would deal with you directly.
If they would cover you for the same amount as if they were paying the hospital directly, it would make no difference to them and if you were in a position to get the second procedure half price, with the savings you would make, this would cover any loan costs you might incur. After all if you put it on your cc. you usually have three to four weeks before you pay the bill.
It makes sense from the practical and medical point of view not to have two admissions.

Re: Discrimination on Pricing-Health Insurance Procedure

Was speaking to consultants secretary and she is going to see if she can do anything on pricing. She has to await official approval from Vivas for first procedure before trying to negotiate on it. If she doesnt get anywhere with this I will certainly approach Vivas as you suggest.
Thks very much for your input.

Bearing in mind that I don't know what the procedure you're getting done is, perhaps you should take a consumerist approach to the matter and tell the hospital that if they don't lower the rate you'll have both procedures carried out elsewhere.

At the very least, make sure the consultant's secretary conveys that message when she's talking to the hospital *nudge, nudge, wink, wink* .

Important caveat: I don't know anything about your treatment or condition, so please make sure to discuss with your consultant before making any decisions. A change in venue may mean a longer waiting time, which may or may not have an affect on your health.

Best of luck with the ops in any case.