Health Insurance

Blanco100 · 17-01-2021 2:26pm #1

Looking for some advice in relation to health insurance for kids.

Recently signed our new born up in December 2020 (born in October 2020), through my work policy which is excellent cover.

Long story short, little one spent 1 week in temple Street over new years with respiratory problem (all good in the end, no procedure needed just observation).

We were never asked about private cover, but today we got a bill for the statutory charge of €80 per night as public patient. Rang temple Street and they sent out private patients forms to be sent back waiving our right as public patient.
Costs as private patient are €1000 per night and if I sign we are liable for shortfall if we are not fully covered (exact same care for €400 and €5k I might add).

The issue is that without a procedure code (there was no procedure) our insurer cannot specifically say if we are covered until forms are submitted to them (at which stage I'll have waived right to be a public patient) and will not be able to pay the €400 after the fact if that makes sense.

Now I'm sure enough I'd be covered but seems like a crazy system to not know your liability before committing?

Anyone have any experience of public v private in these instances?

wonski · 17-01-2021 2:31pm

Does your insurer not cover public hospital stay same way other medical expenses are refunded whick would make it a lot easier?

I would check with them first before paying 400 of course.

Blanco100 · 17-01-2021 2:47pm

wonski wrote: »

Does your insurer not cover public hospital stay same way other medical expenses are refunded whick would make it a lot easier?

I would check with them first before paying 400 of course.

They do but not sure why they can't confirm this over the phone first

LegacyUser · 17-01-2021 5:20pm

Hi there,

They have sent you the public levy charge, but your insurer will cover this directly with hospital. Do not allow hospital to â€˜switchâ€™ to private, as your child did not recience private treatment. The waiver form is supposed to be signed on the day of admission (the hospital know this well, they are just changing their arm) and if you sign, you may end of liable for these charges in the likely even your insurer refuses to pay the private charges.

Call the hospital and say you want to keep the levy charge as is, and ask them to forward the claim to your insurer. You might have to sign the form and send it to the hospital first, but make sure hospital settle the 80â‚¬ with the insurer. Donâ€™t worry about procedure codes, they are not relevant when patient goes pubic such as your case.

shesty · 17-01-2021 5:49pm

Go public.You did not receive private treatment. Be aware that if you sign now they will send you the private insurance forms for any future admission too, once they know you have cover.They will even pre-populate them, so all you need to do is add a signature.....This is their new trick, sending the bills out afterwards.Often it is just information tbh, not anything that you need to do.Mind you, it is better than the phase they had of trying to get parents to sign at 3am or similar, when they were sitting by a child's bed.

Blanco100 · 17-01-2021 8:23pm

shesty wrote: »

Go public.You did not receive private treatment. Be aware that if you sign now they will send you the private insurance forms for any future admission too, once they know you have cover.They will even pre-populate them, so all you need to do is add a signature.....This is their new trick, sending the bills out afterwards.Often it is just information tbh, not anything that you need to do.Mind you, it is better than the phase they had of trying to get parents to sign at 3am or similar, when they were sitting by a child's bed.

They actually did send out the pre populated forms afterwards when I queried the public bill. Is there actually private care at all in such an instance?

But paying €400 as a public patient what's the point in having private insurance at all?

And surely the insurer can tell you if you are covered before you sign?

shesty · 17-01-2021 9:13pm

Eh well unfortunately OP, this is thing that many people don't realise until they come up against the system.

There is no point in having private health care to cover in this particular instance. I assume here your child stayed in a normal bed or ward like all other kids, you stayed with her, there was the usual team of consultants doing ward rounds and she was attended by the consultants that were on call. You didn't actually receive specific private care, am I right? So why would you pay for that as a private patient? I am not criticising the hospital here, they do excellent work, but they are working within a system that is set up to double and triple charge the patient - they can get 5k from your insurer for the nights your child occupied the bed (possibly in addition to the public money funding that )- or they can only get public money that funds that bed (also funded by you btw, through your taxes)

Your insurance might cover (for example) if your child needed an appointment with Orthopaedics, then you could chose to go to the private Temple St Orthopaedic clinic (in the public building), be seen by a private consultant there (most likely also a public consultant in the hospital), who may then treat your child through the hospital (although most likely in public bedsm using the public facilities)....your insurance would cover that instance. But all it buys is you the ability to skip the queue a bit and you would still have to fork out the 150eur per visit fee to see the consultant, before claiming it back. Or if your child needed grommets or something put in in the future, you could go to the Beacon or similar. But in an instance like you describe, your insurance is basically paying out to cover a public bed, in a public hospital, and public consultants - because you have cover. If you are ok with paying that it's entirely your choice tbh, but you are not paying for receiving private care.

I don't know about the insurer being able to tell you if you are covered...I suspect they would pay out, but they are most likely trying to avoid it (and rightly so in this instance).

The problem is the Irish health system here, not anything you are doing.

Millem · 17-01-2021 9:21pm

Blanco100 wrote: »

Looking for some advice in relation to health insurance for kids.

Recently signed our new born up in December 2020 (born in October 2020), through my work policy which is excellent cover.

Long story short, little one spent 1 week in temple Street over new years with respiratory problem (all good in the end, no procedure needed just observation).

We were never asked about private cover, but today we got a bill for the statutory charge of €80 per night as public patient. Rang temple Street and they sent out private patients forms to be sent back waiving our right as public patient.
Costs as private patient are €1000 per night and if I sign we are liable for shortfall if we are not fully covered (exact same care for €400 and €5k I might add).

The issue is that without a procedure code (there was no procedure) our insurer cannot specifically say if we are covered until forms are submitted to them (at which stage I'll have waived right to be a public patient) and will not be able to pay the €400 after the fact if that makes sense.

Now I'm sure enough I'd be covered but seems like a crazy system to not know your liability before committing?

Anyone have any experience of public v private in these instances?

Sorry I am not really following. Your child was in a public hospital and a private room for 5 nights. €1000 per night for single room. They were treated as a public patient with no procedure.
They sent you a bill for €80 for public care.

Look up your hospital cover on the policy. You don’t need any procedure code. Are they covered for a private room in a private hospital?

I remember years ago laya and vhi sending info out re public/private.
I think you can send them the €80 bill?
Look that up. If you are treated as a private patient they don’t want you signing form.

Blanco100 · 17-01-2021 9:38pm

Millem wrote: »

Sorry I am not really following. Your child was in a public hospital and a private room for 5 nights. €1000 per night for single room. They were treated as a public patient with no procedure.
They sent you a bill for €80 for public care.

Look up your hospital cover on the policy. You don’t need any procedure code. Are they covered for a private room in a private hospital?

I remember years ago laya and vhi sending info out re public/private.
I think you can send them the €80 bill?
Look that up. If you are treated as a private patient they don’t want you signing form.

Thanks to everyone for your kind replies. The fact everyone has differing advice shows how disjointed/confusing the system is.

They sent a bill for €400 to be treated as a public patient (€80 per night statutory charge).

I rang Irish life to see if this would be covered they said hospital should have asked about our private cover, got us to sign forms etc..

Contacted temple Street with our insurance details and they sent us prefilled forms for us to return signed (part of it was us waiving our right to be treated as public patients and to be liable for any portion of costs that our insurer won't cover.)

The private fees are €1000 per night for sole occupancy room, which was standard on a new born ward. Consultant fees are extra, but as a previous poster mentioned he was just seen to by consultants on call really which was doing the rounds on those days.

I will only find out if I'm covered AFTER I've signed these forms and temple Street and Irish life engage. By which stage they may say I'm not covered and receive a bill for God knows how much.

And the option to go back and say "actually can I just pay the initial €400" Won't be there any more. I'll be on the hook for a massive bill, which I don't even know what it is. It will only be detailed when I commit to being treated as private patient.

Blanco100 · 17-01-2021 9:46pm

shesty wrote: »

Eh well unfortunately OP, this is thing that many people don't realise until they come up against the system.

There is no point in having private health care to cover in this particular instance. I assume here your child stayed in a normal bed or ward like all other kids, you stayed with her, there was the usual team of consultants doing ward rounds and she was attended by the consultants that were on call. You didn't actually receive specific private care, am I right? So why would you pay for that as a private patient? I am not criticising the hospital here, they do excellent work, but they are working within a system that is set up to double and triple charge the patient - they can get 5k from your insurer for the nights your child occupied the bed (possibly in addition to the public money funding that )- or they can only get public money that funds that bed (also funded by you btw, through your taxes)

Your insurance might cover (for example) if your child needed an appointment with Orthopaedics, then you could chose to go to the private Temple St Orthopaedic clinic (in the public building), be seen by a private consultant there (most likely also a public consultant in the hospital), who may then treat your child through the hospital (although most likely in public bedsm using the public facilities)....your insurance would cover that instance. But all it buys is you the ability to skip the queue a bit and you would still have to fork out the 150eur per visit fee to see the consultant, before claiming it back. Or if your child needed grommets or something put in in the future, you could go to the Beacon or similar. But in an instance like you describe, your insurance is basically paying out to cover a public bed, in a public hospital, and public consultants - because you have cover. If you are ok with paying that it's entirely your choice tbh, but you are not paying for receiving private care.

I don't know about the insurer being able to tell you if you are covered...I suspect they would pay out, but they are most likely trying to avoid it (and rightly so in this instance).

The problem is the Irish health system here, not anything you are doing.

Thank you for your reply.

Still out of pocket €400 for this though when I'm also paying health insurance.

Is there no way Irish life could just cover that portion?

I can see why they would be loathe to give the hospital over €5k for what would cost me €400

wonski · 17-01-2021 9:48pm

1000 is statutory fee for private patient in public hospital. Regardless if it was private room or not.

Talk to the insurer and ask if they can just refund 400 if you pay the bill.

Simple question, should be simple to answer.

Blanco100 · 17-01-2021 9:57pm

wonski wrote: »

1000 is statutory fee for private patient in public hospital. Regardless if it was private room or not.

Talk to the insurer and ask if they can just refund 400 if you pay the bill.

Simple question, should be simple to answer.

Id hope so. I'll hold off on signing the forms anyway for now.

Millem · 17-01-2021 9:59pm

Blanco100 wrote: »

I will only find out if I'm covered AFTER I've signed these forms and temple Street and Irish life engage. By which stage they may say I'm not covered and receive a bill for God knows how much.

But surely you can check your cover? Are you covered for a private room in a public hospital ? It will be be the room charge that will make up the biggest chunk of bill. What did your child have?
If your child had blood tests etc look up pathology cover.

It was the same when I had my babies privately. My husband had to sign a form when I was admitted saying he will be liable of insurance doesn’t pay. For my last baby they even sent the form to me too to sign.

shesty · 17-01-2021 10:02pm

I am sure the insurer will cover you OP to be honest. My niece had this at 6 weeks, about 8 days in TS with Bronchiolitis, no procedures needed. The same scenario played out with her parents. They weren't left on the hook for a bill.

Blanco100 · 17-01-2021 11:01pm

Millem wrote: »

But surely you can check your cover? Are you covered for a private room in a public hospital ? It will be be the room charge that will make up the biggest chunk of bill. What did your child have?
If your child had blood tests etc look up pathology cover.

It was the same when I had my babies privately. My husband had to sign a form when I was admitted saying he will be liable of insurance doesn’t pay. For my last baby they even sent the form to me too to sign.

Blood tests, sleep apnea tests, heart ultrasound and 5 night stay. The bill hasn't been shown to us yet so it's hard to see what we would be charged for privately aside from private room for 5 nights.

Obviously can't cross check with insurer in full because I'll need to tell them specifics the hospital haven't given.

Ideally I'd like to see an itemized private bill, ask insurer if I'm liable for any of it. I might be covered for room but heart ultrasound might be €1k extra that I'm not covered

At that stage I'd have option of cutting my losses and staying public and paying €400. But to see full private bill I'd need to sign forms as private patient waiving my right to be treated publicly.

It's so messy

Evd-Burner · 17-01-2021 11:44pm

I would be very cautious of siging that waiver. God only knows what the shortfall could be.

400 is northing and if you were really left to pay it without the insurance covering you would get 80 back in tax.

My insurance pays the 80 per night standard charge if admitted to hospital overnight, regardless of any procedures.

hdl · 17-01-2021 11:57pm

My child had a hospital stay a couple of years back. Was never asked if we had health insurance and received bill for €400 in the post. Phoned our health insurer who advised me to have the hospital send them the bill. Phoned hospital back with details for them to contact the insurer, and the only thing I heard about it after that was a statement from health insurer to say bill had been paid. I would check with Irish Life again and ask if you can forward the bill to them or if you should have the hospital contact them with the bill. Ours is a fairly basic policy and it was covered, so I would have thought all insurers would cover a public bill. It's surely better for them to settle a €400 bill, than a bill that runs into the thousands?

Sunrise_Sunset · 18-01-2021 12:39am

I would imagine your insurer would partially or fully cover you for going public too, no? You pay the 400 bill then claim back on it afterwards?
My kids are covered with health insurance. My younger child has had stays at hospital for which we went public for. I paid the 80 per night bill and afterwards claimed back on it through the insurance. Therefore, I don't think your total cost would end up being 400.
My child has also been in a couple of times as a day case. No overnight stay but as a bed was needed, it cost 80 each time. However, when we were "checking in" for each of these, I was asked if I had health insurance. When I replied yes, I just gave my details and they sent the bill straight to the VHI, I didn't have to pay up front for it. A few days later I would get a notification of the paid invoice from VHI.

Blanco100 · 18-01-2021 1:23am

Sunrise_Sunset wrote: »

I would imagine your insurer would partially or fully cover you for going public too, no? You pay the 400 bill then claim back on it afterwards?
My kids are covered with health insurance. My younger child has had stays at hospital for which we went public for. I paid the 80 per night bill and afterwards claimed back on it through the insurance. Therefore, I don't think your total cost would end up being 400.
My child has also been in a couple of times as a day case. No overnight stay but as a bed was needed, it cost 80 each time. However, when we were "checking in" for each of these, I was asked if I had health insurance. When I replied yes, I just gave my details and they sent the bill straight to the VHI, I didn't have to pay up front for it. A few days later I would get a notification of the paid invoice from VHI.

Yes but if you say you have private health insurance the bill is higher than €80 per night. VHI would have been sent a bill for higher than 80 per night and if they refused to pay then you are liable for higher private fee rather than 80 per night. In my case the fee is 80per night public, 1000 private. Same hospital, same room.

I'll contact Irish life tomorrow I just hope they are more helpful and don't insist on me ringing the hospital again for the private forms in order to send onto Irish life.

Inpatient stays are usually direct settlement, you don't pay and claim back. It's settled at source. Outpatient, you pay and claim back, that's what I was told.

Gemancy · 18-01-2021 1:53am

We have had 3 hospital admissions with our 3 year old. Each time asked if we had private cover. Told them we do with Laya healthcare but only covered for semi private room in a public hospital. First 2 occasions we were given private room, this was given without our request, which I made clear to staff and admin staff, they advised it was standard where possible to give private room to all kids under 2. (Cork) Most recent admission was on general ward. Signed whatever form they gave me each time and insurer paid Public Health Service charge on all occasions, no hassle. I wouldn’t say our policy is excellent cover but it covers that! I’m sure yours will too, there was a big drive a couple of years ago from insurance companies encouraging customers to sign that form, if I remember correctly that is.... hope your little one is well on the mend.

Blanco100 · 18-01-2021 2:13am

See even on here it's mixed messages though that's the worry.

"Sign the form" And "whatever you do don't sign it".

Thanks a million for all the replies

Millem · 18-01-2021 7:08am

Blanco100 wrote: »

Blood tests, sleep apnea tests, heart ultrasound and 5 night stay. The bill hasn't been shown to us yet so it's hard to see what we would be charged for privately aside from private room for 5 nights.

Obviously can't cross check with insurer in full because I'll need to tell them specifics the hospital haven't given.

Ideally I'd like to see an itemized private bill, ask insurer if I'm liable for any of it. I might be covered for room but heart ultrasound might be €1k extra that I'm not covered

At that stage I'd have option of cutting my losses and staying public and paying €400. But to see full private bill I'd need to sign forms as private patient waiving my right to be treated publicly.

It's so messy

I can’t see why ILH can’t just tell you over the phone? I generally find them very good?

awec · 18-01-2021 1:42pm

I think there has been some wires crossed here.

Ring Irish Life. Give them the name of the hospital. Ask them what hospital cover you have for that hospital.

It's a very straightforward request. If Irish Life have an online portal it's probably listed there.

Sunrise_Sunset · 20-01-2021 11:38pm

Blanco100 wrote: »

Yes but if you say you have private health insurance the bill is higher than €80 per night. VHI would have been sent a bill for higher than 80 per night and if they refused to pay then you are liable for higher private fee rather than 80 per night. In my case the fee is 80per night public, 1000 private. Same hospital, same room.

I'll contact Irish life tomorrow I just hope they are more helpful and don't insist on me ringing the hospital again for the private forms in order to send onto Irish life.

Inpatient stays are usually direct settlement, you don't pay and claim back. It's settled at source. Outpatient, you pay and claim back, that's what I was told.

Are you covered for public hospitals? Pay the 400 and claim back on that through your insurance.

Shelli2 · 21-01-2021 2:07am

This is from my insurance company's website, but it's clear on the public v private form signing .
_________________
If I have private health insurance, must I sign to be a private patient on admission via A/E to a Public hospital?
MPF members, like all other citizens, pay the required health contributions in their PRSI to gain entitlement to treatment as a public patient in HSE hospitals, if that is their choice. This issue of waiving your right to be treated as a public patient only applies to non-elective admissions such as via Accident & Emergency (A&E).

Public Hospitals can only issue charges to MPF when a member waives their entitlement to be treated as a Public patient by signing a Private Insurance Patient form. This form should not be signed unless it is your choice to do so.

The following is the admission procedure that you should encounter at a HSE Hospital when being admitted via A&E:

Patient must be asked on admission if they wish to waive their right to be treated as a public patient.
If you choose to waive your right to public treatment, it is in order to sign a Private Insurance Patient Form and consent to waive your right to be treated as a public patient. The Hospital are then entitled to charge full private rates for this full hospitalisation at up to €813 per night along with associated professional fees (even if you are hospitalised in a public ward).
If you choose to avail of your entitlement to be treated as a public patient, only sign the Public Hospital Claim Form. In this instance, the hospital is entitled to charge €80 per night, for a maximum of 10 nights and this charge is fully covered by your MPF policy.
There is evidence that some hospitals are insisting that patients admitted through A&E departments must use their private health insurance. This is not correct. If you are content to be treated as a public patient, you can insist on your right to be so treated and cannot be forced to do otherwise. Likewise, you are fully entitled to use your private health insurance and waive your right to be treated as a public patient. However, please note that in the event of being admitted to a public ward, this has no benefit to you as a patient in terms of treatment for this particular hospitalisation.

Members admitted via A&E have advised that they are also receiving Private Insurance Patient forms to sign after their discharge from hospital. In this scenario the hospitals have not adopted the correct procedures and are attempting to reclassify the hospitalisation as private in order to charge private rates. They cannot do so unless a patient waives their right to public treatment by signing the Private Insurance Patient Form. We urge members not to sign forms in this situation.

The additional costs incurred by the Fund for paying private rates for public beds does have an impact on the subscription rate that you as a member will ultimately pay for your private health insurance policy so your vigilance in this area will benefit you and all fellow members.

Sparrow09 · 22-01-2021 2:32pm

Hi there,

I work in this industry so hopefully this is helpful.

1. Your child was treated as a public patient, and this is fine! Your insurer will still cover the public costs. In fact, the insurers encourage you to ‘go public’ in public hospitals unless you feel there will be a benefit for you ‘going private’ (private room, directly seeing the consultant, etc).

2. Definitely do not opt to go private at this stage. The hospital are actually not allowed do this, but I imagine they were planning on sneakily pre-dating the form to make to make it look like you signed on admission...

3. What to do...call the hospital, tell them you are happy that your child went public, but that you do have health insurance. Ask them to forward the 80€ X 4 to your insurer. You may have to sign Irish Life’s form for the hospital to submit, so ask the hospital to post this to you (note: this is not the same as signing the public hospital waiver form. The waiver form is a hospital form which you sign on admission to a public hospital if you are opting to be treated as a private patient). Send this back to hospital and they will claim this from insurer directly. Do not pay the public charges, you don’t need to pay a penny.

Best of luck and hope your child is on the mend now.

shesty · 23-01-2021 9:58am

Thanks for that Sparrow, helpful for the rest of us confused beings too!

AndrewJRenko · 23-01-2021 12:06pm

Shelli2 wrote: »

The additional costs incurred by the Fund for paying private rates for public beds does have an impact on the subscription rate that you as a member will ultimately pay for your private health insurance policy so your vigilance in this area will benefit you and all fellow members.

It's a pity that the insurer doesn't highlight the fact that the additional savings incurred by the taxpayer by charging private rates for public beds DOES have an impact on the tax rate that you as a resident will ultimately pay for your health service, so your vigilance in this area will benefit you and fellow taxpayers.

Sunrise_Sunset · 26-01-2021 6:53pm

Sparrow09 wrote: »

Hi there,

I work in this industry so hopefully this is helpful.

1. Your child was treated as a public patient, and this is fine! Your insurer will still cover the public costs. In fact, the insurers encourage you to ‘go public’ in public hospitals unless you feel there will be a benefit for you ‘going private’ (private room, directly seeing the consultant, etc).

Exactly this. Pay the public fee's and claim back on these through the insurer.

Sparrow09 · 26-01-2021 9:57pm

Sunrise_Sunset wrote: »

Exactly this. Pay the public fee's and claim back on these through the insurer.

No they shouldn’t self pay - the insurer will pay this directly to the hospital.

Sunrise_Sunset · 26-01-2021 10:37pm

Sparrow09 wrote: »

No they shouldn’t self pay - the insurer will pay this directly to the hospital.

Oh right, ok. I've done both ways in the past for different treatments for my kids.
1. Went public but told hospital I had insurance and the insurer paid this upfront. I only knew it was 80 per day when I got the claim notification from VHI to say it was all paid.
2. Paid upfront, and then claimed back through insurance. I don't think this was for day cases/overnight stays though, as far as I remember.

Health Insurance

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