Health Insurance Laya Ophthalmic cover 20% 'shortfall'

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elcato

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Am I correct in assuming that if a procedure costs 5k and they have a 'shortfall' of 20%, then I will be charged 1k ? Just checking there's no extra sur[rises.
 
charlie007 said:

Health Insurance - Shortfalls in Orthopaedic & Ophthalmic Procedures.

I have received my Laya Simplicity quote, up from €1665 to €2003. Ouch. I've looked at alternatives and see that Optimum Premium is cheaper and has better day to day cover. It also has a 20% shortfall for the above procedures where Simplicity has none. It has been mentioned here in the past...
www.askaboutmoney.com

Check post 18.
Click to expand...
Thanks - Didn't see that thread. Unfortunately, I'm still confused. When I put the procedure into their website to check cover it states a 20% shortfall which is OK. But it then explains that I need to contact the hospital to find out how much this is.
My understanding of your port is that Laya have a set price with the hospital (Beacon) and I give the hospital 20% of that figure.
 
That was a ballpark figure that Laya gave me for knee surgery.
I don't believe the hospitals will give you an exact number.
I wanted to know if the 20% shortfall would be off the insurers preferential rate with the hospital and they confirmed this to be the case.
You should of course always enter the procedure code which you will get from your referring medic.
An admittance excess could apply but these are usually not excessive! and are only charged once.
Possible overnight shortfalls are a different story but in Laya Simplicity there is none for The Beacon!
Best of luck.....
 
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