Health Insurance Laya stop refund for psychotherapy

poka

Registered User
Messages
9
Hello there,
I get 50 % back on day to day expenses with my laya policy. I attend a psychotherapist for talk therapy, which I started last year. I submitted my receipts to laya for 2019 and received my 50 % refund, no problem. However, the same receipts for 2020 have been rejected, laya stated my policy does not cover this claim. I rang laya and they said they will no longer cover receipts from psychotherapist they will only cover psychiatrists. Laya said they are tightening up on what receipts they accept. I thought this unfair, I did not get any notice they were changing my policy. I was thinking are laya forseeing a large amount of psychotherapy appointments after the trauma of covid 19 and is now rejecting receipts they accepted last year ? Should a health insurance company inform policy holders when there is a change in what they offer in their policy. Talk therapy is 70 euro for 1 hour....not very affordable for most people.
 

mathepac

Frequent Poster
Messages
7,100
Psychiatrists and other medical professionals may refer patients to psychotherapists for specialist work. With their work-loads they often haven't the time in their schedules for the "therapeutic hour" of talk therapy. This sounds like a major change. Was your referral personal or a medical one?
 

poka

Registered User
Messages
9
Psychiatrists and other medical professionals may refer patients to psychotherapists for specialist work. With their work-loads they often haven't the time in their schedules for the "therapeutic hour" of talk therapy. This sounds like a major change. Was your referral personal or a medical one?
I was referred by my medical doctor. My issue under the same policy, laya will no longer pay out on psycotherapist under my day to day expenses. They will only pay out on psychiatrist, which are highly specialised and not for counselling. Extremely disappointed with laya as no refund (50% previously) on 70 euro visit will limit the numbers of visits individuals can afford.
 

elacsaplau

Frequent Poster
Messages
834
Hi Poka,

I agree with you and empathise. Personally, I find the disclosure from LAYA and other health insurers to be very poor.

Our family plan is through my wife's work with Irish Life Health. We get all this nonsense each year - the most egregious part being some form of "reasons why" letter which starts off with something like...…"having considered your personal situation, etc., we recommend the blah, blah policy for you, etc., etc."...………...IT'S A GROUP POLICY!!…….has everyone in my wife's work got identical needs to us??!!……...and precisely what review did they do on us??!!

In the case of LAYA, if anyone thinks that they are covered for cancer, be careful. LAYA claims to cover chemo but in my experience (via a close friend a while back)…..what LAYA means is that it covers certain forms of chemo but not others - but in any reasonable reading of the point of sale material, this distinction is, not at all, made clear.

[To elaborate, when diagnosed with stage iv cancer, part of one's hope is that some new drug will come along that will reverse the anticipated trajectory of the disease. New drugs do come along which can be of great benefit including extending lifespan and dramatically improving the quality of life. This drugs are proprietary, in huge demand, the outcome of massive R&D, etc. and as a consequence likely to be very expensive. My friend thought that he would be covered for one such drug but he wasn't. They were apparently too new, too high-tech. What's really bad is that some people will not be able to afford the correct treatment. The "too new" bit is really deplorable because without substantial means, the impact will be that if, the much hoped and prayed for, new drug does come along...……...Mr. Ordinary may not be able to afford it personally and his insurance won't cover it.]

The specific questions that I would like to know are:

1. What precise disclosure requirements health insurers are obliged to follow?

2. Can anyone show me anywhere in LAYA's communications which addresses the OP's concern and my concern in relation to cancer drugs? Specifically, where in the point of sale material was the OP advised the his/her psychotherapy fees would no longer be covered? And where in relation to chemo treatment is it made clear that certain therapy will be covered and other therapy denied? [For the avoidance of doubt, the chemo in question was recommended by his oncologist and is considered international best practice therapy as he used an "international second opinion service."

3. What is the independent redress channel / arbitrer in relation to health insurers? Is it the FS&PO?
 
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sadie

Frequent Poster
Messages
620
LAYA told me before that counselling and psychotherapy is not covered by health insurers, unless the therapist was a registered psychologist registered with the PSI ( same as with Revenue). Technically you can't claim on your Med1 either.
Anecdotally I heard friends say they included counselling receipts in their Med1 claims and got tax relief.

Unless your therapist is a 'practitioner' which is (quoted below from Revenue.ie).

2.3 Definition of “Practitioner”?
Practitioner means any person who is: a) registered in the register established under section 43 of the Medical Practitioners Act 2007; b) registered in the register established under section 26 of the Dentists Act 1985; c) in relation to health care provided outside the State, entitled under the laws of the country in which the care is provided to practice medicine or dentistry there.

In the case of a psychologist or psychotherapist, relief is only available where:  the psychologist or psychotherapist is a qualified practitioner as defined by section 469 TCA 1997, or  where a patient is referred by a practitioner for a diagnostic procedure.

Psychologists and speech and language therapists are designated professions for the purposes of the Health and Social Care Professionals Act 2005 but counsellors and psychotherapists are not incorporated by CORU.
 

Early Riser

Frequent Poster
Messages
783
Psychologists and speech and language therapists are designated professions for the purposes of the Health and Social Care Professionals Act 2005 but counsellors and psychotherapists are not incorporated by CORU.
That makes sense. Yet Laya (and perhaps others) cover homeopathy?
 
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RedOnion

Frequent Poster
Messages
4,436
Anecdotally I heard friends say they included counselling receipts in their Med1 claims and got tax relief.
Just on the tax piece. You can claim anything you want on Med1 and get relief. Until they ask for evidence, and then you could end up paying penalties for underpayment of tax. We've a self assessment system, so just because you get relief doesn't mean it was legitimate.
 
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