Advice - pay public or let them arrange via private?

gmisk

For some background I am currently in James hospital - approx 9 days will be 11 when done approx.

I am in as a public patient on a public ward (came in via a and e directly) I have had maybe 2 CTs, 3 ultrasounds etc.

I was asked to sign a form when arriving by billing but refused due to morphine etc.

I do have private health insurance with Irish life.

Kick-Off Plan ILH.

Had a long time and only used sparingly.

So my question is what should I do? Should I continue to insist I am public pay the 800 euro max stay plus whatever other fees. Or should I go back to the hospital sign doc and let them take over using my health insurance details. No idea what will cost more etc. Irish life hard to get through and email responses are vague.

Thanks so much

MojoMaker

it's not like car insurance, there is no "no claims bonus", so claim away - it's why you pay a health insurance premium after all - to defray costs when you get in trrouble.

gmisk

https://www.boards.ie/discussion/comment/119431398#Comment_119431398

Thanks for the quick reply. It's not the no claim part. It's just I have no idea if the cost might end up being more than if I just pay myself public.

But your right why am I paying it if not to use it!

Mitzy

Unless you have a medical card there is a charge of €80 a night for a maximum of 10 nights in a 12 month period in a public hospital in Ireland. So if you don't put it through your health insurance & you do not have a medical card you would have to pay €800.

gmisk

https://www.boards.ie/discussion/comment/119431404#Comment_119431404

I did see that, I think probably easier to just go via them and irish life Kick-Off Plan ILH.

Really appreciate the quick responses :)

coylemj

The medical insurance companies advise their customers to resist signing that form. You can see their financial interest in this but I happen to agree with them - if I'm paying PAYE and PRSI, why should my medical insurance pay for a service (treatment in a public bed in a public hospital) that I and everyone else is entitled to for free?

If you tell them your insurance details, you will effectively be paying for the service twice. I'd be pretty certain that your insurance will cover the daily charge, it's certainly in their interests to cover it, if it means their customers won't land them with the full bill for their stay in a public hospital.

Irish Life Health sent the following in an e-mail to their customers in October 2019....

Don't be charged as a private patient if you're not getting private treatment

Your private health insurance cover is with Irish Life Health, which gives you access to a wide range of private hospitals. However, you may still need to use the public system if you're admitted to hospital via A&E, for example.

If this happens, the hospital may ask you to sign a 'Private Insurance Patient Form' which gives the hospital permission to charge your health insurer for your stay. If you choose to sign the form, you waive your right to be treated as a public patient. This means you'll be charged as a private patient - but you may not get any additional services such as a private or semi-private room. It is your choice whether to sign this form or not.

As a tax payer, you are entitled to avail of the public health system regardless of whether you have health insurance or not.

So, if you're asked to sign the from, you should ask the hospital what additional services you will receive by waiving your right to public treatment? If the hospital is not going to provide you with any additional services, you're fully entitled to not sign the form.

If you do sign the form, you will be giving the hospital permission to charge your health insurer for your stay. This means you're essentially paying twice for your stay in a public hospital, once through general taxation and again through your private health insurance. These costs are ultimately being reflected in your health insurance premium.

Jim2007

https://www.boards.ie/discussion/comment/119433108#Comment_119433108

Let me start by saying that I have no experience of health insurance in Ireland nor for that matter a Public Health Service, since we don’t have one in Switzerland.

But I think the OP needs to answer the question, why are they paying insurance in the first place? I assume the insurance company’s model for calculating premiums is based on the assumption that people will avail of it to the max and priced accordingly. There is nothing you can do to reduce your taxes, so you are paying for two services regardless. Insurance company’s suggesting you leave them out of the equation is an advantage for them, but you are still left paying the same double coverage.

if the objective is to have a fall back plan, is there a better option, I don’t know, just wondering.

redlough

https://www.boards.ie/discussion/comment/119433108#Comment_119433108

Insurance company tell person paying premium not to claim in shocker.

Will they reduce your premium for not claiming? answer is no.

E30M3

https://www.boards.ie/discussion/comment/119433383#Comment_119433383

Most people pay Private Health insurance to minimise waiting lists and access to diagnostics/consultants. However if you go into Hospital through A&E there is generally no provision for different treatment/accommodation for Public or Private Patient's, I'm not saying there should or shouldn't be.

The treatment therefore should be available to you for a max amount of €80 X 10 as per every other citizen who does not hold a medical card, however the Hospital will charge the Health Insurer potentially 000's for this treatment if you sign the waiver form.

Ultimately this to me is paying privately for a service you are entitled to as a citizen for €800 max and if unchallenged will contribute to the pressure on health insurance premiums for all members, therefore I would not sign the form personally.

coylemj

https://www.boards.ie/discussion/comment/119433383#Comment_119433383

If everyone with private insurance resists the temptation to sign that form, it will reduce premiums.

The HSE is simply milking people who happen to have private insurance. VHI, Irish Life etc. are handing over millions of their subscribers' money every year, for nothing.

Allinall

https://www.boards.ie/discussion/comment/119433383#Comment_119433383

I got a rebate from my insurer because of reduced claims.

gmisk

https://www.boards.ie/discussion/comment/119433560#Comment_119433560

Ok so if I don't sign it.

What do I do?

I go back to Irish life directly and they shouldn't charge me as I should be covered?

It's all a bit odd.

E30M3

https://www.boards.ie/discussion/comment/119433656#Comment_119433656

Hope you are feeling better and over the worst gmisk.

You really need to speak to someone in Irish Life to find out what your plan covers in this regard and ask them if you can claim back the 80 daily charge on your plan.

redlough

https://www.boards.ie/discussion/comment/119433538#Comment_119433538

Irish Life made profits of nearly 200m last year.

It's not people making claims in hospitals that are pushing up your premiums!! it's the year on year profit requirements for these companies that push them up!!

During the pandemic when the claims was at an all time low, I got 50 euro or something back from VHI and I pay them thousands every year for my family.

gmisk

https://www.boards.ie/discussion/comment/119433688#Comment_119433688

Yeah I have been trying. But pdf I have for this hospital says covered so pretty confident it will.

Will try them again tomorrow :)

gmisk

https://www.boards.ie/discussion/comment/119433688#Comment_119433688

Thanks for this.

Got through they said just give my details and they will sort out I won't be charged anything.

coylemj

https://www.boards.ie/discussion/comment/119433847#Comment_119433847

Irish Life told you to give the hospital details of your insurance cover?

E30M3

https://www.boards.ie/discussion/comment/119433758#Comment_119433758

Irish Life or Irish Life Health?

I got a rebate of €600 this year for a family of four so I'd check that 50 if I was you, that could be a mistake or you may be misremembering.

I don't pay premiums in the expectation of a rebate, I am paying for cover and peace of mind but I of course welcome any savings that are refunded to me.

Jim2007

https://www.boards.ie/discussion/comment/119433538#Comment_119433538

But 800 Euro does not represent the full cost of care. Why should the taxpayer sub private insurance companies???

Bass Reeves

https://www.boards.ie/discussion/comment/119434414#Comment_119434414

Why should a taxpayer pay for a service that they should receive anyway

cython

https://www.boards.ie/discussion/comment/119434144#Comment_119434144

Quite possibly, yes. Some (maybe all) insurers have direct settlement arrangements with hospitals for the €80 per night, meaning they will cover that rather than the customer paying and claiming. The paperwork for that is separate from that which allows the hospital to bill the insurers for the full cost of treatment, and requires the policy details to be processed.

redlough

https://www.boards.ie/discussion/comment/119434188#Comment_119434188

You are paying for health insurance but then don't recommend to use it

In terms of their perfomance, they don't spilt out and are part of Great West so you don't want to know what profits they make per year.

In reality the people who are getting hit when hospitals are not getting paid are the employees, the nurses etc. Since I have started paying health insurance I have never seen premiums decrease year on year. So no idea why people would think not making claims will reduce them?

WE have seen with car insurance etc the number of claims have reduced yet premiums have not in line with the reductions.

To me, the more money the HSE can get the better as they need it.

P.S. I don't pay in expectation of a rebate. I was making a point that when insurance companies had a huge decrease in claims etc due to covid the saving was not passed onto the customer.

gmisk

https://www.boards.ie/discussion/comment/119434144#Comment_119434144

Irish life health (private health insurance) told me to give my policy number etc to hospital.

E30M3

https://www.boards.ie/discussion/comment/119434727#Comment_119434727

They recommend you make an informed choice rather than recommending you don't use it. The choice is then yours.

Unclear what you mean by hospitals not getting paid. Public hospitals are funded by the exchequer and salaries are set centrally also. Staff are paid irrespective of whether or not a Health Insurer is charged for a service you are already entitled to as a citizen. Private Health Insurance is to supplement the public System, not replace your entitlements under that system.

And I pointed out I received a 22% rebate this year so clearly the savings due to lower claims were passed on to me, the customer. Remember the Government also levy Private Insurance premiums in Ireland and you Premium payment includes that also.

Furze99

https://www.boards.ie/discussion/comment/119433108#Comment_119433108

So basically they want you to pay your premium to them AND also pay up to the max in the public system. You'd be mad to do this unless you can submit the fee you pay to the insurers and get a refund? Either way, it's morally corrupt advice.

Wheety

I'm with Laya and they suggest you don't give your policy number if you're not getting anything extra. Think they're charged a few hundred a night rather than the public fee of €80.

They say they will reimburse the standard fee to me.

Jim2007

https://www.boards.ie/discussion/comment/119434659#Comment_119434659

I have no idea! But apparently some people are paying twice once in taxes and once via private insurance. The part I don’t get is why they should then go out of their way to give the insurance a free pass so they don’t pay anything at all. It free money for the insurance company.

E30M3

https://www.boards.ie/discussion/comment/119435557#Comment_119435557

Think of Health Insurance as supplementary rather than replacement. If you need diagnostics, access to a consultant or elective treatment all of those have various waiting lists on the public system but with Health Insurance you can get a referral to a Service and access it privately in a shorter timeframe.

I'm not saying that this is a good system but it is the current system. If you have Private Health Insurance you have a chance to deal with health issues without depending on a waiting list that could stretch for years in certain disciplines.

Additionally many Health insurance policies cover some of your day to day expenses such as GP visits or scans, minor injuries clinics and of course people should and do reclaim these routinely.

Jim2007

https://www.boards.ie/discussion/comment/119434727#Comment_119434727

I'm just trying to understand it and in particular what the OP paid for as it seem to be a case of at least being double insured for at least parts of it.

Bass Reeves

https://www.boards.ie/discussion/comment/119435557#Comment_119435557

It's not giving the insurance companies a free pass. What we do know is that our taxes will not decrease. We also know that the health services will swallow any money they get without too much of a visual improvement in services

What you have to hope os that natural competition will keep prices lower in the HI sector. All individuals have access to corporate plans. These companies will tender and shop around for HI for there employees. There are is at least four companies operating in Ireland I think. They will compete for market share, you have to hope that natural competition will allow you see the benefits of such actions.

15 years ago there was only two companies providing farm insurance in Ireland. The smaller one was acquired by a large insurance company. They started to grab a higher share. By moving to them at the time my farm insurance dropped by 30%. However when they reach a stage they allowed prices to rise again. However over the last 5m6-7 years three more insurance companies have entered the market. My premiums have dropped by 33% even though I have more covered and a higher level of cover.

Competition is all you can hope for

Furze99

Surely the health insurance companies are playing the system with this advice. They are advising customers to go public in order to avoid paying out the full amount that they should be paying.

Long past time to split the public & private health services in this country. Let the health insurance companies have their own services and anyone who has health insurance goes to them, paying top ups if necessary. If they end up in public A&E, the public service charges patients or insurance companies at same rates they charge in the private hospitals.

This idea of health insurance as a top up scheme is morally corrupt and discriminates against whole sections of the population.

E30M3

https://www.boards.ie/discussion/comment/119437850#Comment_119437850

You are saying that if someone wishes to take out Private Health Insurance they should lose the right to be treated as a public patient?

And they pay a Government levy for this privilege?

I disagree with your view

Bass Reeves

https://www.boards.ie/discussion/comment/119437850#Comment_119437850

So if I pay my taxes like everybody else and then choose to pay for private HI as that should disqualify me from using the public system my taxes pay for. That interesting. What about if I have a permanent health insurance policy that will pay me lump sum if I develop certain conditions, should I have to spend that before I avail of the public health service

Jim2007

OK, to draw this thread back to the OPs issue.

This seems to be a useful post:

https://www.boards.ie/discussion/comment/119439941#Comment_119439941

masterboy123

My story of having a private health insurance:

I took VHI when I was 32 and, in the same year had an emergency procedure done. I was admitted via A&E and kept in a semi-private room. There were daily investigations and morning consultant reviews.

I was very happy that I had VHI. Because I realised I could have been in another room sharing with six others and where the consultant doesn't see patients daily.

And I paid zero euros. Although the VHI summary indicated, that the total hospital bill was around €5000. That day I decided to continue with VHI.

I do acknowledge that a semi-private/private room may not be available at all times