Health Insurance Shortfalls in Orthopaedic & Ophthalmic Procedures.

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charlie007

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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 that hospitals have waived this in negotiation.
It seems most other healthcare providers also have this 20% shortfall.

Could anyone who has succeeded with this, or knows of someone who has, please confirm.
 
Hi Charlie,

Interesting query :)

Back in recession I rang Mater and Blackrock and presumably because so many people were cancelling their health insurance the hospitals were finding times tough too so they confirmed that they would consider each individual case at that time. You could try giving them a call and just sound them out. They were very helpful and approachable so might be worth a try.

BTW a 20% shortfall is mild compared to some of the VHI policies this year which have dropped the cover from 80% to 60%.

There would appear to be about €181.10 in the difference in the premiums. As you rightly point out the day-to-day cover is a lot better and there are quite a number of higher excesses on the Simplicity.

Definitely something that you will need to consider carefully :)
 
I definitely know of somebody who had to pay the shortfall in blackrock - was a reality check for me!
 
Sue Ellen said:
Hi Charlie,

Interesting query :)

Back in recession I rang Mater and Blackrock and presumably because so many people were cancelling their health insurance the hospitals were finding times tough too so they confirmed that they would consider each individual case at that time. You could try giving them a call and just sound them out. They were very helpful and approachable so might be worth a try.

BTW a 20% shortfall is mild compared to some of the VHI policies this year which have dropped the cover from 80% to 60%.

There would appear to be about €181.10 in the difference in the premiums. As you rightly point out the day-to-day cover is a lot better and there are quite a number of higher excesses on the Simplicity.

Definitely something that you will need to consider carefully :)
Click to expand...
Cheers Sue Ellen,

A bit of a minefield to measure, but as of now thinking of staying where I am.

I'll try a phone call all right but they'll hardly promise anything extra?!

Decisions, decisions.
 
Below is comman corporate plan with 20% excess inspire plus .

Health Insurance Comparison Tool | HIA

Compare health insurance plans across a wide variety of providers in Ireland. You can also compare your current health insurance plan with other plans available.
www.hia.ie www.hia.ie
 
irbx said:
Below is comman corporate plan with 20% excess inspire plus .

Health Insurance Comparison Tool | HIA

Compare health insurance plans across a wide variety of providers in Ireland. You can also compare your current health insurance plan with other plans available.
www.hia.ie www.hia.ie
Click to expand...

That's quite a decent 20% shortfall plan, but note the day to day cover is capped at €1000.

Simplicity is €7650 and this might be important for some.
 
irbx said:
Can roughly how much extra was 20% excess? Are taking more then 1000 euro just to have idea of exposure
Click to expand...

If the shortfall is anywhere near €1000, then Optimum Premium makes sense for me.

However I had a figure of 15k-20k per procedure in my head.

Can anyone advise on the cost of say knee and hip replacement?
It's virtually impossible to find this out on the Hospital sites.
 
charlie007 said:
If the shortfall is anywhere near €1000, then Optimum Premium makes sense for me.

However I had a figure of 15k-20k per procedure in my head.

Can anyone advise on the cost of say knee and hip replacement?
It's virtually impossible to find this out on the Hospital sites.
Click to expand...
Think my knee HTO cost about €8K in the Santry Sports Clinic so probably a similar figure for the less intrusive easier knee / hip replacements
 
Sue Ellen said:
Looks to be lots more than €1,000. The hospitals do deals with the health insurers hence their Fixed Price Procedures but AFAIK they are restricted to them. See here for examples of prices.
Click to expand...

Thanks again..
If the insurer has a preferable rate with the hospital, do you think they (the hospital) would have to charge pro rata to the patient for the shortfall?
The insurer sends bills they have paid to the insured, so they (the insured) will know what was charged.
Hope that makes sense:)
 
charlie007 said:
f the insurer has a preferable rate with the hospital, do you think they (the hospital) would have to charge pro rata to the patient for the shortfall?
The insurer sends bills they have paid to the insured, so they (the insured) will know what was charged.
Click to expand...

Don't fully understand your point but still think that you should give some of the hospitals a call and sound them out :)

You probably need also to take into consideration your age, health and the likelihood that you will need to avail of this cover.
 
Thanks again Sue Ellen,

I think I'm taking most of those things into consideration.

I suppose my question is:
Hospital charge insurer €14k to for knee replacement. However a patient would be charged €17k by them since they wouldn't get the insurance company deal.
If I present with a 20% shortfall policy, is my hospital bill €2.8k or €3.4k??
 
I've just talked to Laya, very helpful as usual.

They mentioned that Private Hospitals typically do NOT make up the shortfalls.

A ballpark figure for knee surgery would be €10k.
This would be the cost to them (Laya) and the 20% shortfall would be calculated from this ie €2k.

Also confirmed that an upgrade on day to day cover, re Optimum Premium , kicks in immediately.
However downgrading Orthopaedic & Ophthalmic cover would lead to a 2 year waiting period for any future upgrade of same.

If anybody has had any of these procedures, posting a ballpark figure on the costs here would I think be of further help....
 
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