Private Endoscopy - Insured, but Self Pay

TheKevin

A few quick questions on this topic. My GP referred me to Vincent's for a gastroscopy. This is to evaluate the progression of a preexisting condition, and Laya will not cover it. I've had gastroscopy for the same condition years ago before moving to Ireland.

1) I am fine with paying, but can I expect the procedure to cost at Vincents?

2) GP informed me that the consultant's office will contact me within a few weeks. Is this to schedule the procedure or another consultation before the procedure? This is a chronic condition, so I would like to avoid a superfluous consultation. As my oesophageal symptoms have recently become quite bad, I'd like to get the procedure completed as quickly as possible. Is there any way to politely request a sooner appointment?

sullivlo

Costs and processes vary from hospital to hospital. Your best bet is to contact the receptionist of the consultant you have been referred to and see what their protocol is. For example, I was referred for a colonoscopy and needed to see the consultant first; my gran was referred and just had the procedure. Both in the same hospital, just under different consultants. So different protocols.

With regards costs - again, it's hard to know. Are you being referred publically or privately? Why won't Laya cover it - and is it just that procedure itself that they won't cover, or will they not cover any of the assosciated costs?

For scheduling, again, you'll need to talk to the secretary. Be warned that they hear from patients day in day out about how bad their condition is and how they deserve to be seen quicker - it doesn't really wash with them so don't be put off by a firm no. What I have found helpful in the past is that I have been asked to be put on a cancellation list and confirm that you can attend at short notice. That may speed things along.

goldenhoarde

TheKevin wrote: »

A few quick questions on this topic. My GP referred me to Vincent's for a gastroscopy. This is to evaluate the progression of a preexisting condition, and Laya will not cover it. I've had gastroscopy for the same condition years ago before moving to Ireland.

1) I am fine with paying, but can I expect the procedure to cost at Vincents?

2) GP informed me that the consultant's office will contact me within a few weeks. Is this to schedule the procedure or another consultation before the procedure? This is a chronic condition, so I would like to avoid a superfluous consultation. As my oesophageal symptoms have recently become quite bad, I'd like to get the procedure completed as quickly as possible. Is there any way to politely request a sooner appointment?

Sounds like Laya won't cover the initial consultant's visit but they will most likely cover any tests/procedures that they order for you. (again take this with a pinch of salt as the actual policy you are on may not) Also is the consultant approved for Laya? if not then you would pay

sullivlo's post has more info and questions

sullivlo

goldenhoarde wrote: »

Sounds like Laya won't cover the initial consultant's visit but they will most likely cover any tests/procedures that they order for you. (again take this with a pinch of salt as the actual policy you are on may not) Also is the consultant approved for Laya? if not then you would pay

sullivlo's post has more info and questions

Laya won't cover the consultant visit. Or rather the consultant visit fee will go towards medical expense claims at the end of the year.

Generally, endoscopies are covered to some level on most policies - maybe 75% on some, but generally private treatment in a public hospital tends to be covered. However if it is a pre-existing condition that requires a waiting period to be served, then the insurer don't have to cover it until the waiting period (usually 5 years) is served.

For example, Johnny has no health insurance but decides to get some. In his application form he says that he has epilepsy. Outpatient treatment will not be covered by the insurer unless the waiting period has been served with another insurer and there has been no lapse in policy. However, if Johnny took out health insurance and THEN was diagnosed with epilepsy, the treatment would be covered - does that make sense?

So it's not just the policy details that are needed, but the pre-existing conditions listed that aren't covered.

Generally one waiting period will suffice, as in you do your waiting period for your illness with Laya and transfer to VHI without any lapses in insurance, and you're covered.

Corruptedmorals

Usually you would need to be seen by either the consultant or a member of his/her team if public before having any procedure done. It would be unusual to just go by a referral letter and either schedule a procedure or stick you on the waiting list without ever seeing you first.

It would be useful to have any correspondence or reports from the previous scope at this appointment. Double check this with the secretary, the clinic could email it across directly if in English or you could bring it yourself and translate if needed.

Health insurance will not cover private consultant visits. These costs (expect circa €200 for the first visit) are redeemable at the end of the year from your health insurer and/or the Med 1 form from Revenue. The amount you get depends on your plan and then for Revenue you can only claim on whatever amount not covered by the health insurance.

As for the procedure, they wont cover when it's designated as a pre-existing condition and it's a long waiting period- 5 years I think. The hospital may be able to advise on the self-pay amount as a private patient. If you go publically you will be waiting ages if you're not deemed urgent.

Dingle_berry

A potential extra cost is pathology. If biopsies or blood samples are taken private patients will be charged. Check if your insurer will cover these.