VHI and the "repeat rule" - what's this?

sitstill

I had a colonoscopy and treatment in May at the Beacon for which I claimed from VHI. Unfortunately, I need to have the treatment done again because it was not entirely successful. When I spoke to a woman from VHI she told me that they will only pay for one colonoscopy every 36 months "unless the procedure is allowable under the repeat rule" and I should check this with the surgeon prior to having the procedure.

Does anyone know what this means or if it sounds like my case will be allowed? I rang the surgeon today but he was not available. Thanks.

NuMarvel

I haven't heard it called the repeat rule, but there is a list of medical reasons as to why a repeat colonoscopy would be covered by a health insurer. All health insurers have the same 36 month rule, I think it's based on best medical practice.

The list is in the book that VHI send to consultants every year, so it's probably better to talk to your consultant to see if your case falls into one of those exemptions. For your own sake, ask him to confirm which exemption your case comes in under in case there's any confusion later. FYI, the list is all medical jargon, so don't be afraid to ask him to repeat it often and slowly

broker2008

The Beacon could be the reason.

sitstill

NuMarvel wrote: »

I haven't heard it called the repeat rule, but there is a list of medical reasons as to why a repeat colonoscopy would be covered by a health insurer. All health insurers have the same 36 month rule, I think it's based on best medical practice.

The list is in the book that VHI send to consultants every year, so it's probably better to talk to your consultant to see if your case falls into one of those exemptions. For your own sake, ask him to confirm which exemption your case comes in under in case there's any confusion later. FYI, the list is all medical jargon, so don't be afraid to ask him to repeat it often and slowly

Thanks for your help!

sitstill

broker2008 wrote: »

The Beacon could be the reason.

Why's that?

AngryLips

sitstill wrote: »

Why's that?

Their medical care might be the best money can buy but I've heard their medical treatment is quite the opposite.