How to budget for possible operation, incl. change health insurance.

FionnK86

How do I budget for a possible operation? Will a doctor tell me how much it could cost?

I've a problem with my Eustachian tube since June 2020. My RH ear is blocked about 5 times per day, I perform the Valsalva maneuver and it clears it, but it's really annoying. I went to a doctor in 2021, she prescribed decongestant and it helped a little bit but not enough. I've looked at YouTube videos, read articles and talked to a person in work who'd the same issue and it looks like I will need to get an operation under anesthetic where they insert a grommet in my ear.

I have Laya's Assure Protect scheme which covers me for day-case/out-patient, semi-private and a short fall for private hospital cover. I don't know what the operation would fall under.

Jim_Hodge

Ask a doctor. Grommets are routine day procedures usually. Kids get them regularly.

Your insurer should also be able to tell you exactly what you're covered for.

the_amazing_raisin

As I recall the doctor will probably refer you to a consultant for specialist care. They might refer you to a specific consultant they know or just give a generic referral and you find your own. Your insurance company should also have a list of consultants that are set up to claim from them directly

After the initial consultation the consultant will (hopefully) devise a treatment plan and if an operation is required they can give you a code that you can check with your insurance company

The operation will likely be covered under day patient hospital cover, but you will have to pay the excess. I think the consultant can often claim directly from the insurance but you'll need to check this

The consultation can probably be claimed against day to day expenses, usually there's an allowance for consultants in there. Same goes for any follow up consultation needed

If you're under general anesthesia then I think you need to be in a hospital. You'll need to check with the consultant which hospital they're operating out of and then plan travel expenses accordingly

Word of advice if you've never been under anesthesia, you'll basically be useless for about a day afterwards. I was under for probably 30 mins max and there's around a 5 hour gap where I know I was awake but I've no idea what I was doing or saying to anyone

So you'll definitely need someone to look after you for the day to ensure you don't set yourself on fire or end up under a bus

You might need to fast for 12 hours beforehand to ensure you don't vomit while under anesthesia. If memory serves they try to do the day procedures early, so you'll be fasting from the night before. They'll keep you around the hospital for a few hours afterwards to make sure you won't pass out and then when the doctor is happy they'll send you packing

The hospital will hopefully feed you, but maybe bring a bag with some snacks and water just in case. Plus phone charger and a book since you'll be bored as hell waiting

Best of luck, hope you get sorted

Ha Long Bay

If you log into the Laya site you can check to see if the procedure is covered there might be an excess based on your policy.

https://www.layahealthcare.ie/checkcover

The procedure code for this is 1785 (Myringotomy with insertion of grommet)

If you are an adult this procedure is done under local anastatic (no fasting) and takes less that 5 minutes and completely painless.

Before getting to that stage though the consultant might ask for tests like a CT scan, MRI, hearing test etc. Again depending on your plan some or most costs will be covered. There will also be consultation fees and multiple visits so factor in them costs and how much Laya reimburse.

As other posters said best of luck and feel free to ask on the thread or via PM if you have anymore questions.

AndrewJRenko

Were you with Laya at the time the condition was diagnosed? If not, waiting period of up to five years would apply.