HSE Refund? Am I entitled? How do I claim?

CiaraScully

Hi

I had to go to the doctor and was told that my medical card had been cancelled (even though it was valid until 2018) and to contact them. I had my doctor visit and paid €50 and called The HSE straight after.
They had my incorrect information on their system, and cancelled my card as I had not responded to a letter they had sent out to me. The letter had been sent to CORK and I live in MAYNOOTH and have never once lived in Cork!!!! :mad::mad:
I was so sick I just started crying on the phone to the gentleman and he was very understanding, and the issue with that has been fixed.:(

But my question is, since it was their negligence and incorrect information which led me having to pay a doctors fee, am I entitled to get a refund from The HSE or would they have to contact my doctor? I am a full time student and I only work 2 days a week, so to me €50 is a lot of money!

If anyone has any advice I would be so grateful!
Thank you for reading

JCX BXC

I'll send ya the €50 if its causing you that much stress.

I'd say it'll be hard to get the €50 back, pressure them enough and they might. Start with a call to their customer service and see if there's any procedure in place for this.

coylemj

If the HSE fixed up your medical card then what you need to do is check if you had the cover maintained without a break in which case your GP would be paid the full capitation grant for you and you can ask for that fee to be returned. The HSE wouldn't be a party to that discussion but morally you would be entitled to get the money back from the GP. If there was a break in your medical card cover then they are entitled to the fee and frankly I cant see you getting satisfaction on any front.

Lux23

I think the doctor should refund you, not the HSE. The doctor should never have charged you at the time, they should have waited to see what had happened. And really it was your fault for not responding to the letter.

ohnonotgmail

coylemj wrote: »

If the HSE fixed up your medical card then what you need to do is check if you had the cover maintained without a break in which case your GP would be paid the full capitation grant for you and you can ask for that fee to be returned. The HSE wouldn't be a party to that discussion but morally you would be entitled to get the money back from the GP. If there was a break in your medical card cover then they are entitled to the fee and frankly I cant see you getting satisfaction on any front.

If the card was cancelled it would be have to be reissued. i cant see how there wouldn't be a gap in cover.

CiaraScully

Lux23 wrote: »

I think the doctor should refund you, not the HSE. The doctor should never have charged you at the time, they should have waited to see what had happened. And really it was your fault for not responding to the letter.

They had sent the letter to Cork. I have never lived in Cork. Somehow my address on their system was changed, I never called them to alter my address. It was not my fault.

davo10

Lux23 wrote: »

I think the doctor should refund you, not the HSE. The doctor should never have charged you at the time, they should have waited to see what had happened. And really it was your fault for not responding to the letter.

The op was not covered by a medical card for treatment at the time and there was no guarantee would be covered in the future. The GP can only charge based on eligibility on date the treatment was provided. This is an issue between the op and the HSE.

Kristopherus

davo10 wrote: »

The op was not covered by a medical card for treatment at the time and there was no guarantee would be covered in the future. The GP can only charge based on eligibility on date the treatment was provided. This is an issue between the op and the HSE.

If the GP is paid by PRS, then he is duty bound to refund to the OP.

ohnonotgmail

Kristopherus wrote: »

If the GP is paid by PRS, then he is duty bound to refund to the OP.

bound by what? if the OPs card was cancelled at the time they visited the GP what obligation do they have to provide free treatment?

davo10

Kristopherus wrote: »

If the GP is paid by PRS, then he is duty bound to refund to the OP.

Only if the card was valid at the time, it wasn't.

Kristopherus

ohnonotgmail wrote: »

bound by what? if the OPs card was cancelled at the time they visited the GP what obligation do they have to provide free treatment?

davo10 wrote: »

Only if the card was valid at the time, it wasn't.

If/when the card is renewed, it is usually renewed back to the date the last one expired. The GP then gets paid, so its his/her duty to refund.

davo10

Kristopherus wrote: »

If/when the card is renewed, it is usually renewed back to the date the last one expired. The GP then gets paid, so its his/her duty to refund.

Should they refund? Maybe, is it their "duty" to refund, absolutely not. When the op presented at the clinic he/she did not have a valid card and as such was treated as a private/fee paying patient. Back dating the card is up to the HSE but the HSE would be responcible for their error and the op can apply for a refund from them, not the GP.

L1011

The HSE would disagree with you if the card was backdated. They paid (eventually) for cover.

davo10

L1011 wrote: »

The HSE would disagree with you if the card was backdated. They paid (eventually) for cover.

They won't disagree with me, I work in the health system. I've been through this before with both the HSE and the Dept of social welfare (PRSI benefit scheme) they cannot and will not require retrospective refunds for patients who have backdated eligibility.

L1011

Not what I saw, repeatedly, working with primary care. Complaint gets made, very nasty letter from the PCRS follows.

Never saw what the next stage was if a contractor refused - never knew one that did. A change of doctor request would likely be put in for one! Even if their only standing is sending nasty letters, they still do it.