Consultant's help claiming from VHI

araic88

I sought prior approval for treatment abroad from VHI. They (eventually-after several appeals!!) agreed to pay and did indeed reimburse me for the first of two surgeries. It had been outlined to them there would be two surgeries nd I ASSUME they accepted that when they said they'd cover the "treatment" but I was a bit worried they wouldn't actually pay the second unless I got prior approval again (I know I'm fussing but it's a lot of money to lose on fine print!) , so rang to ask did I need to. In fairness the woman was actually very nice on the phone but couldn't really help and said to have my consultant contact VHI ( through the provider support or something, a special one for the referring doctors I think) to check.

Basically, that could take forever with the consultant (I was never really his patient, he referred me after one or two appointments) if it involves any sort of form filling lol, does anyone know how the system works and would it be a simple case of the consultant phoning to check?

Wasn't sure where to post this, so posted it in two forums, hope that's okay it's just I need to sort this a.s.a.p.

Thanks for any help!

broker2008

All claims under this section of the policy must be pre approved. I think you are wise to check out if the 2nd procedure will be covered. After all you will be paying the bill upfront and relying on the VHI to pay you back. Is the 2nd procedure medically necessary or cosmetic? That's the crux. Have a look at downloads section on VHI website for a pre authorisation form. VHI will in turn make contact with consultant after form is received to fulfill all their requirements and arrive at their decision, By the sounds of your post, the authorisation for the 2nd operation would appear to be not yet approved.

araic88

Thanks It was quite a lot of hassle getting approval the last time, but definitely took less time than it would have to earn the money I got back!!
It's craniofacial work which is why they felt at first it was "cosmetic" before agreeing it was necessary. To be honest, consultant did a poor job of filling out forms first time (actually using the word cosmetic a few times! big no-no!) so I wasnt surprised they turned it down.
The time they accepted, I had actually filled them out myself and brought them to consultant who read what I had written and happily signed his name Might do the same again!!

broker2008

Yeah I thought that. People can get fairly stressed out over this issue. MUST be medically necesary with all 3 companies. The medically necessary procedures in most instances are cheaper abroad than good old Ireland. The companies require the pre authosrisation to ensure that they are not getting hoodwinked. Consultants can also raise the expectations of the patients because they feel it should be paid for, but then again they are not the ones who would be paying for it.

araic88

Have to say, having not needed to deal with VHI much before (luckily) I found it a bit confusing and arduous, but in fairness they came up trumps quite quickly to reimburse me.
I accidentally got them a good deal with the hospital in England. It's a private hospital and on the forms I ticked that I was 'self paying' (as I was temporarily!!) but it turns out this meant the hospital fee was quite a bit less than would have been, as self pay patients get a 'reduced package' which really means people with insurance have to pay more...i.e. insurance companies get charged more than neccessary which seems rather unfair. Is that normal?
But yeah the fees still weren't very high compared to what people have told me they'd be here.

Thanks for the response broker2008

broker2008

araic88 wrote: »

as self pay patients get a 'reduced package' which really means people with insurance have to pay more...i.e. insurance companies get charged more than neccessary which seems rather unfair. Is that normal?

It is normal. I heard of a case recently where a well known hospital halved the price for a procedure for someone who didn't have the full level of cover for their hospital for their plan.