Health Insurance Health insurance cover query

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blanketyblank

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Hi, I have VHI Company plan plus level 1 cover and I thought I was covered in a public hospital for everything. Recently however they have told me I'm not covered for a test I went for which was a stress test as it was diagnostic! I cant understand this twas done in a public hospital! I have never phoned or queried cover when I've gone to a public hospital _ only when I've gone to a private one. In fact once when I rang a public hospital once to look for a procedure number they couldn't give one as they didnt do that!
They say I have to pay and claim back half. I'm worried now about other things I've had done
And whether they were covered as they've not been processed yet. .
Can anyone explain this to me? If it's not covered as its diagnostic ( her words) what else could it be that would be covered?
 
Hi,

Just in case some of the more knowledgeable people here don't see your post but hopefully they will reply in more detail in due course :)

My understanding is that per the Table of Benefits for this policy that you are covered for your accommodation 100% in a public hospital:

Section 1 - Hospital charges A Public 1 & 2 hospitals  Day care, side room, semi-private & private accommodation Full cover

For diagnostic procedures cover you should refer to Sections 8 and 9 of the same Table of Benefits for your policy as linked to above. This is because they are out patient procedures and are treated differently. It is best to check with VHI each time you go for any treatment/procedures like this to ensure that you are aware of the costs involved. Hopefully your other items will be covered to some extent also or possibly full cover and VHI should be able to confirm this also.

You may also be able to claim tax relief on the expenses which might lighten the burden.
 
Sue explained it very well above.

It appears that you are being treated as a private patient in a public hospital. Did they ask for your insurance details when you got the test done? Did you have to fill out any forms? In particular did you sign any waivers (waiving your right as a public patient and stating you are a private patient)?

Whether you get treated as a public or private patient in a public hospital is your choice. The charge for a hospital appointment (where a procedure is done) as a public patient is €80. I'm not sure if this also applies for diagnostic tests but I thought it didn't. There is a commitment from government to get rid of all of these fees by April. Depending on the cost of the test it may by more beneficial for you to pay this fee instead of claiming privately. There is also a chance there may have been no fee as a public patient.

In general if you are just visiting a doctor for a consultation or you are getting diagnostics done it's considered an outpatient appointment.
If you are getting treatment done, whether in the same day (side room or day case) or overnight you are considered an inpatient.
 
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I am trying to get my head around this I'm attending the consultant privately so yes a private patient In a public hospital

I just thought my plan covered everything in a public hospital!

I'll have to try and read up parts of my policy!

Just a question _ so if I go to a public hospital I can opt to be a public patient even though I'm attending the consultant privately?
 
blanketyblank said:
I am trying to get my head around this I'm attending the consultant privately so yes a private patient In a public hospital

I just thought my plan covered everything in a public hospital!

I'll have to try and read up parts of my policy!

Just a question _ so if I go to a public hospital I can opt to be a public patient even though I'm attending the consultant privately?
Click to expand...
No, in order to be a public patient you must get into the hospital via a public patient pathway. Eg either via referral, say from an A&E visit or from another public hospital doctor. Or via the public waiting list for a specialist, say from a GP referral.

Some public hospitals still have private wings or sections. From what your saying it sounds like you didn't wait publicly, rather you went straight as a private patient to a consultant, who just happens to be running their consultation rooms in a public hospital. In this case you are fully a private patient. In fact there is a chance your consultant might also work out of a private hospital and you could switch to visiting them there if you so wished to.

If the Slaintcare contracts come through this situation will no longer be allowed. Public hospitals would only be available through the public patient pathways. Private patient pathways would only be available in private hospitals. It would certainly make it a bit easier to wrap your head around.

As it stands though, as a private patient the consultant and the hospital are two different things. You pay to see the consultant of your choice and they in effect rent the facilities of the hospital.
 
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@Starrynights

Very informative post above, thanks for this. As its hard to keep up with these matters, just wondering is it also the case that you will get your test quicker if you are attending the consultant privately and your test is in a public hospital that they work out of, or is there only one waiting list for all, which should be the case?
 
In theory it shouldn't be quicker if it's in a public hospital. The HSE is supposed to follow the common waiting list method. This means that if you go privately to a consultant and get a diagnosis and subsequently need a test or procedure with a waiting list, you should be placed onto that waiting list in the same position as someone who had to wait for a public outpatient appointment. For example if the wait for the test is 6 months and you also skipped the queue to see the doctor by 6 months, you should in theory wait 12 months to get tested so as not to penalize those who are fully public. This is even if you are a private patient for the test or procedure. This only applies to public hospitals. How good they are at actually enforcing this in real life though is really unknown.

The new Slaintecare consultant contracts aim to eliminate this problem altogether by not allowing consultants to do private care in public hospitals at all.
 
Starrynights said:
No, in order to be a public patient you must get into the hospital via a public patient pathway. Eg either via referral, say from an A&E visit or from another public hospital doctor. Or via the public waiting list for a specialist, say from a GP referral.

Some public hospitals still have private wings or sections. From what your saying it sounds like didn't wait publicly, rather you went straight as a private patient to a consultant, who just happens to be running their consultation rooms in a public hospital. In this case you are fully a private patient and it works exactly the same as if the consultant was working in a private hospital. In fact there is a chance your consultant might also work out of a private hospital and you could switch to visiting them there if you so wished to.

If the Slaintcare contracts come through this situation will no longer be allowed. Public hospitals would only be available through the public patient pathways. Private patient pathways would only be available in private hospitals. It would certainly make it a bit easier to wrap your head around.

As it stands though, as a private patient the consultant and the hospital are two different things. You pay to see the consultant of your choice and they in effect rent the facilities of the hospital.
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Sorry, I realise this seems to contradict what I said here about going public from a private consultation. If the consultant agrees ( and works in the public hospital ) you should be able to switch to public status but as I mentioned above in theory you should be waiting the same time as if you saw the consultant publicly from the start. What you can't do is get your tests/treatment as a public patient but have all your consultations continuously private.

Also some public hospitals have what look like standalone private clinics. For example Beaumont has Beaumont Private Clinic. Same in St James's. I've no experience with this so I'm not sure if they can get you faster tests or treatment as a private patient.
 
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If I may ask this question, GP has referred me to ent consultant but it looks like 6 months to a year just to see them, if I go back to my GP and get a referral to a private consultant will my public appointment be cancelled?
 
horse7 said:
If I may ask this question, GP has referred me to ent consultant but it looks like 6 months to a year just to see them, if I go back to my GP and get a referral to a private consultant will my public appointment be cancelled?
Click to expand...

No, they are separate systems. If you have a copy of the original referral letter to the public consultant then you can use that for the private consultant also.
 
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