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How do Health Insurance Claims work

  • 28-10-2021 8:35pm
    #1
    grape3012
    Registered Users, Registered Users 2 Posts: 17 ✭


    A recent experience has me questioning how the Health Insurance system actually works - would appreciate any insights.

    Earlier this year I saw a GP who referred me to an ENT consultant on the basis that I had private health insurance.

    The ENT consultant charged me €200 for the consultation. I then claimed €100 back through my insurance. At the appointment the consultant put a camera up my nose (not my throat). I notice on my insurance account that the ENT consultant then claimed €140 for scope of the larynx under local anaesthesia (I thought this would be part of the initial consultation).

    So the appointment cost me €100 after claim, it cost insurance provider €240 and the consultant gets €340 - this just seems bananas.

    (sidenote: the ENT told me absolutely nothing for €340)

    Tagged:


Comments

  • #2
    Jim2007
    Moderators, Business & Finance Moderators Posts: 10,606 Mod ✭✭✭✭Jim2007


    what is your specific question? Were the charges not in line with your policy? Was part of your claim refused or what?

    If you want to discuss the merits of public policy this is not the place for it and I will move it.



  • #3
    grape3012
    Registered Users, Registered Users 2 Posts: 17 ✭grape3012


    https://www.boards.ie/discussion/comment/118088004#Comment_118088004

    No I don't have a grievance with what I was charged and I don't think it is a question of public policy.

    How does it work with health insurance and consultants that a consultant can charge a rate where they know I can claim 50% but then also charge full cost for a procedure to the insurance company. Does the consultant have an agreement with the insurance company also?



This discussion has been closed.
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