VHI & Cardiologists

Wheelsonthebus

Hi All,

I've been referred by my GP to a cardiologist for tests. After many long calls to VHI, my GP, cardiologists offices, it looks like VHI pretty much dont cover you for anything in this situation.

After several long-winded conversations with VHI (really frustrating, they just say everything in a very evasive convoluted way) it looks like the only real thing they cover is €60 towards the cost of seeing the cardiologist. None of the tests etc. are covered unless performed "in a hospital setting".

After ringing around a few different cardiologists- it's pretty clear that no cardiologist performs these "in a hospital setting".

I'm basically looking at shelling out €500- which is pretty outrageous considering I have VHI and pay my taxes.

Does anyone have any experience with this? Would appreciate any advice you may have...

Thanks.

username123

Wheelsonthebus wrote: »

Hi All,

I've been referred by my GP to a cardiologist for tests. After many long calls to VHI, my GP, cardiologists offices, it looks like VHI pretty much dont cover you for anything in this situation.

After several long-winded conversations with VHI (really frustrating, they just say everything in a very evasive convoluted way) it looks like the only real thing they cover is €60 towards the cost of seeing the cardiologist. None of the tests etc. are covered unless performed "in a hospital setting".

After ringing around a few different cardiologists- it's pretty clear that no cardiologist performs these "in a hospital setting".

I'm basically looking at shelling out €500- which is pretty outrageous considering I have VHI and pay my taxes.

Does anyone have any experience with this? Would appreciate any advice you may have...

Thanks.

I cant speak specifically from experience with cardiologists, but certainly when I saw an ENT recently he wanted me to have a CT scan of the sinuses and referred me to a private clinic who it turns out, is not covered by VHI. I queried VHI on it and was told that because it wasnt a VHI approved clinic - no go. Now I dont know what a clinic has to do to be VHI approved, the CT scanner looked like something out of Stargate, it certainly wasnt just some dude with non scientifically tested equipment waving smoke signals at me - so I told VHI that I thought they were a bunch of complete scammers and that they should be approving these places, but presumably dont because they dont get a kickback, suffice to say I hung up annoyed to say the least.

Next stop was the ENTs office, well, sure - he could have referred me elsewhere but the wait for these machines in 'a hospital setting' is so long that its counterproductive, what I would have spent in pain medication and sinus steroids in that time frame would cover the cost of the scan so why not send someone somewhere they can have it done in a matter of days than a matter of months?

The whole thing is a complete joke. Do any of the other insurers cover the tests needed?

Wheelsonthebus

username123 wrote: »

I cant speak specifically from experience with cardiologists, but certainly when I saw an ENT recently he wanted me to have a CT scan of the sinuses and referred me to a private clinic who it turns out, is not covered by VHI. I queried VHI on it and was told that because it wasnt a VHI approved clinic - no go. Now I dont know what a clinic has to do to be VHI approved, the CT scanner looked like something out of Stargate, it certainly wasnt just some dude with non scientifically tested equipment waving smoke signals at me - so I told VHI that I thought they were a bunch of complete scammers and that they should be approving these places, but presumably dont because they dont get a kickback, suffice to say I hung up annoyed to say the least.

Next stop was the ENTs office, well, sure - he could have referred me elsewhere but the wait for these machines in 'a hospital setting' is so long that its counterproductive, what I would have spent in pain medication and sinus steroids in that time frame would cover the cost of the scan so why not send someone somewhere they can have it done in a matter of days than a matter of months?

The whole thing is a complete joke. Do any of the other insurers cover the tests needed?

Thanks 123, seems like a right scam altogether. I asked could they tell me which clinics are approved in Limerick. They just basically avoided what I was getting at and just kept saying that the two hospitals were approved.

It's hilarious in this country, get a job- pay your taxes, you think that should be enough to cover you- no. Get VHI on top of that to make sure you're covered- no still not enough. You still have to shell out. No such thing as public healthcare, no such thing as private healthcare.

To be honest I wouldn't even know where to begin when it comes to switching insurers. This is complicated enough!

Spook_ie

Having been through alot of tests & surgery, the bottom line is that the VHI will only completely cover you for tests if you are an in-patient, nearly everything else is charged for and you claim it back at the end of the year, which of course is peanuts compared to how much you have forked out. OH recently had an MRI as an outpatient in the Hermitage which shock horror was actually completely covered by the VHI, but the consultant also wanted an x-ray done but that wasnt covered so 112 euros please.......:rolleyes:.

Wheelsonthebus

Spook_ie wrote: »

Having been through alot of tests & surgery, the bottom line is that the VHI will only completely cover you for tests if you are an in-patient, nearly everything else is charged for and you claim it back at the end of the year, which of course is peanuts compared to how much you have forked out. OH recently had an MRI as an outpatient in the Hermitage which shock horror was actually completely covered by the VHI, but the consultant also wanted an x-ray done but that wasnt covered so 112 euros please.......:rolleyes:.

Ya I was thinking that seems like they'd only cover you if you showed up in the back of an ambulance at the hospital. Preventative healthcare- ha?
I wasn't expecting them to cover everything to be honest just some of it. Really takes the biscuit that they dont even partially cover you because it doesn't take place "in a hospital setting".

Funny that the clinic is run by a consultant who in a hospital setting is A1. But in his private clinic he's not approved. Makes a pile of sense doesn't it?

Spook_ie

The bit I find hard to understand is why the VHI will cover certain procedures on an out patient basis in some clinics/hospitals but not others.......you really have to trawl through their terms and conditions to find out which procedure/test is covered in x clinic/hosp, or another way is to phone the accounts dept of x clinic and ask if your test is on a "Direct payment settlement with the VHI"

drzhivago

Wheelsonthebus wrote: »

Hi All,

I've been referred by my GP to a cardiologist for tests. After many long calls to VHI, my GP, cardiologists offices, it looks like VHI pretty much dont cover you for anything in this situation.

After several long-winded conversations with VHI (really frustrating, they just say everything in a very evasive convoluted way) it looks like the only real thing they cover is €60 towards the cost of seeing the cardiologist. None of the tests etc. are covered unless performed "in a hospital setting".

After ringing around a few different cardiologists- it's pretty clear that no cardiologist performs these "in a hospital setting".

I'm basically looking at shelling out €500- which is pretty outrageous considering I have VHI and pay my taxes.

Does anyone have any experience with this? Would appreciate any advice you may have...

Thanks.

Traditional insurance policies covered in-patient care almost exclusively and little else

Newer policies cover some outpatient expenses but not all

CT scans take short time and are a very useful investigation and the scanners are a dime a dozen, if VHI covered all these they would be paying out more than they take in in membership

The real issue is when Universal health Insurance comes in what would you be willing to pay for insurance and what would you be willing to have as a co-pay for tests

_Whimsical_

I was interested to notice this has become a trend. I have a relation who has been told she needs to see two specialists for a potentially serious illness. However the GP recommends not to go private despite her having top notch heath insurance as the costs of the type of tests that will be required will run into thousands. Instead she's waiting on the public list which seems risky under the circumstances. I'm really starting to wonder what the point of paying insurance is when this is what you're faced with when you might have a serious condition.

bleg

What level VHI cover did you have?

_Whimsical_

bleg wrote: »

What level VHI cover did you have?

You're probably not talking to me here but I decided to answer seeing as no one else did. My relation has Aviva Business Plan Complete cover, it's at least equivalent of VHI Plan C Options and pretty wide ranging with good hospital cover. However it seems that if you see a consultant privately you are only covered for tests if you are in a bed, be it in a public or private hospital.

After speaking about this with people this week I've found that it's common practise to be admitted to a bed in a private hospital for a night just to have an MRI scan so the price of the scan will be covered along with the price of the bed. I've spoken to someone else who recently had a small operation in a private hospital. She said her consultant told her it would be a day procedure if she waited on the public list and she would be able to go home that evening, however to have it performed quickly she would have to go private and have a 3 day stay in hospital if it were to be covered as that was the particular private hospitals arrangement with her insurance provider.Anything less than 3 days was not covered.She opted for 3days in a bed in a private room. Is it any wonder insurance prices are sky rocketing ?

beeno67

_Whimsical_ wrote: »

You're probably not talking to me here but I decided to answer seeing as no one else did. My relation has Aviva Business Plan Complete cover, it's at least equivalent of VHI Plan C Options and pretty wide ranging with good hospital cover. However it seems that if you see a consultant privately you are only covered for tests if you are in a bed, be it in a public or private hospital.

After speaking about this with people this week I've found that it's common practise to be admitted to a bed in a private hospital for a night just to have an MRI scan so the price of the scan will be covered along with the price of the bed. I've spoken to someone else who recently had a small operation in a private hospital. She said her consultant told her it would be a day procedure if she waited on the public list and she would be able to go home that evening, however to have it performed quickly she would have to go private and have a 3 day stay in hospital if it were to be covered as that was the particular private hospitals arrangement with her insurance provider.Anything less than 3 days was not covered.She opted for 3days in a bed in a private room. Is it any wonder insurance prices are sky rocketing ?

However health insurers audit these things on a regular basis. They get the medical notes from the hospital. When you sign the form on admission you agree to allow them do this. If they feel you were admitted to hospital for investigations or treatment that could have been carried out as an outpatient then you are liable for all the money for the hospital stay. Usually €500-800 a night

_Whimsical_

beeno67 wrote: »

However health insurers audit these things on a regular basis. They get the medical notes from the hospital. When you sign the form on admission you agree to allow them do this. If they feel you were admitted to hospital for investigations or treatment that could have been carried out as an outpatient then you are liable for all the money for the hospital stay. Usually €500-800 a night

Wow I didnt know that. I'd say a lot of people would be interested to hear that!

drzhivago

There are a few risks to being admitted for tests like this, VHI may reject payment to hospital and now after the tests you will have to pay for the 3 night stay also

From experience of a lot of medical buddies VHI are rejecting a lot of stuff now saying not medically necessary ie elderly person admitted with stroke 100 day stay in hospital, VHI saying should have been discharged after day 20 or 30 and thus not paying either hospital or consultant for the additional days, consultant "loses" €2,500 hospital loses €70,000 in a public hospital such is the charge set by the minister for a private bed

Gives some idea of where the premiums go

OMD

drzhivago wrote: »

There are a few risks to being admitted for tests like this, VHI may reject payment to hospital and now after the tests you will have to pay for the 3 night stay also

From experience of a lot of medical buddies VHI are rejecting a lot of stuff now saying not medically necessary ie elderly person admitted with stroke 100 day stay in hospital, VHI saying should have been discharged after day 20 or 30 and thus not paying either hospital or consultant for the additional days, consultant "loses" €2,500 hospital loses €70,000 in a public hospital such is the charge set by the minister for a private bed

Gives some idea of where the premiums go

I don't understand the last bit "gives some idea of where the premiums go".

drzhivago

OMD wrote: »

I don't understand the last bit "gives some idea of where the premiums go".

That the premiums dont just going to pay for consultant bills.

In many cases the majority of bills will be the hospital element and in a significant number such as with stroke the amount paid to the hospital far outweighs what is paid to the consultant

erge if Minister reilly has his way and anybody who has private insurance who goes to a public hospital and is admitted their insurance will be charged the privilege of the visit whether patient occupies private or public bed

That will dramatically increase costs in the short term.

_Whimsical_

drzhivago wrote: »

erge if Minister reilly has his way and anybody who has private insurance who goes to a public hospital and is admitted their insurance will be charged the privilege of the visit whether patient occupies private or public bed

That will dramatically increase costs in the short term.

That's very interesting to hear that insurance companies are challenging stays. A pity that they're doing it to stroke patients and seriously ill patients when if anecdotal evidence is to be believed a problem with non necessary stays seems to happen more in private hospitals for elective procedures and with tests that might be able to be had without a stay.

I find it hard to see sense in the idea of private patients paying over the odds for beds in public hospitals. Will that not risk reinforcing a two tier system in these cash strapped times? Will a hospitals with budget problems not be forced to prioritise giving beds to private patients to create more revenue when allocating beds for A&E patients and elective patients?It seems like it could be a dangerous move in that regard.

drzhivago

_Whimsical_ wrote: »

That's very interesting to hear that insurance companies are challenging stays. A pity that they're doing it to stroke patients and seriously ill patients when if anecdotal evidence is to be believed a problem with non necessary stays seems to happen more in private hospitals for elective procedures and with tests that might be able to be had without a stay.

I find it hard to see sense in the idea of private patients paying over the odds for beds in public hospitals. Will that not risk reinforcing a two tier system in these cash strapped times? Will a hospitals with budget problems not be forced to prioritise giving beds to private patients to create more revenue when allocating beds for A&E patients and elective patients?It seems like it could be a dangerous move in that regard.

Apologies if i mislead you it is not just stroke patients that VHI are looking at I used that as an example as most would know that a person with stroke only leaves the hospital when they are rehabilitated enough, VHI now say they don't pay for rehabilitation

Regarding non necessary stays the term they use is "medical necessity has not been established for this admission please refer to member"

Which means hospital and consultant will now come to patient looking for money, they did provide a service

Regarding the "two-tier system" in public hospital the effect of the ministers dictate will be they can charge for any bed if the patient chooses to be private so they will only have to be admitted to a bed so it removes that aspect you are concerned about. as all patients should be waiting less than 9 hours from admission decision to resting in a bed then that should even the playing field

I think elective admission is soon to be a term of the past as there are no more beds

opinion guy

drZ,

Where does the money go when a cardiologist orders a test like an outpatient echo or CT scan ?

drzhivago

opinion guy wrote: »

drZ,

Where does the money go when a cardiologist orders a test like an outpatient echo or CT scan ?

Forgive the long winded and possibly evasive sounding answer

essentially as an outpatient Most Insurance companies expect you to pay for the services and then at years end make a claim for recouping amounts in excess of whatever the particular deductible on the policy type is

ECHO
Patient pays a cost to have the test done AND reported. There is One charge to them which is in fact two fees, the technical fee for the cost of using the machine and also the report fee for the particular specialist. In some cases specialists own the machine so the technical fee also goes to them to pay for the machine

CT SCan
Same as above although capital cost higher so in many cases the hospitals will own the scanner, in a limited number of multi specialist radiology practices they may also own the scanner and hence the fee

There are also a number of imaging centers, most common Euromedic. This is a huge corporation which has multiple imaging modalities at multiple sites who hire specialists to work for them on a contract basis. this can reduce their costs as they can feed scans to one central area for reporting

I hope this helps

opinion guy

drzhivago wrote: »

Forgive the long winded and possibly evasive sounding answer

essentially as an outpatient Most Insurance companies expect you to pay for the services and then at years end make a claim for recouping amounts in excess of whatever the particular deductible on the policy type is

ECHO
Patient pays a cost to have the test done AND reported. There is One charge to them which is in fact two fees, the technical fee for the cost of using the machine and also the report fee for the particular specialist. In some cases specialists own the machine so the technical fee also goes to them to pay for the machine

CT SCan
Same as above although capital cost higher so in many cases the hospitals will own the scanner, in a limited number of multi specialist radiology practices they may also own the scanner and hence the fee

There are also a number of imaging centers, most common Euromedic. This is a huge corporation which has multiple imaging modalities at multiple sites who hire specialists to work for them on a contract basis. this can reduce their costs as they can feed scans to one central area for reporting

I hope this helps

Interesting. So if insurance does cover the scans is there a difference in where the money goes ?

drzhivago

opinion guy wrote: »

Interesting. So if insurance does cover the scans is there a difference in where the money goes ?

Im afraid I am not a private consultant so the limit of knowledge is what i have had to do for myself and family members or those I refer for tests who come back to me with results because wait too long in public sector

I am not aware of all that insurance will pay for as an outpatient but I believe the more expensive a test is the more likely VHI in particular will have negotiated a deal with a particular hospital per region to cover the test upfront if patients go there as opposed to in other situations having to pay for it themselves and trying to recoup

kerry365

Can anyone tell me what is the "average plan" that might cover you for something someday as all the others plans are 'flexible' and we are clueless where we stand. I am with VHI. Paid €1,800 last year and just got this year's bill not for €2,234. Was I asleep when price rise announced. I am trying to get an appointment with an eye specialist costing €180 and will pay another €60 to my GP to be referred and VHI will cover nothing..... I am really gob-smacked about the whole situation.

Spook_ie

kerry365 wrote: »

Can anyone tell me what is the "average plan" that might cover you for something someday as all the others plans are 'flexible' and we are clueless where we stand. I am with VHI. Paid €1,800 last year and just got this year's bill not for €2,234. Was I asleep when price rise announced. I am trying to get an appointment with an eye specialist costing €180 and will pay another €60 to my GP to be referred and VHI will cover nothing..... I am really gob-smacked about the whole situation.

We are still with VHI, we've had alot of medical bad luck in the last few years so we'll stay put for the time being, however, have a look at Laya, their website is fairly user friendly and definately cheaper than VHI. At the end of the day you really need to decide a couple of things ...
1. If I require in-patient care, what hospital do I want to be treated in ?
2. How much, if any, excess am I prepared to pay for inpatient care
3. How much I want to be covered on everyday expenses
Its very tough out there and certainly we scrutinise our renewals every year as they nearly always change something !!!