Health Ins Claim Refused

Deleted User wrote: »

Mater Private has got rid of its multiple occupied rooms to being solely single occupied. I was told when recently in Beacon that they are changing likewise but have not done so yet; they are expanding into adjacent building. The thing about the room I recently occupied was that it was smaller than a public one I occupied in Vincent's public hospital. My point is that there wasn't much of an advantage in having private insurance to achieve this pretty identical level of comfort/privacy. My admission was not elective for surgery.

Also I was listening today about health insurance in the radio and how eg, VHI are no longer fully covering joint replacement surgery, at least on my plan of over €3K and that many other insurance plans no longer fully cover such surgeries. It's becoming less attractive to have health insurance in my experience.... except I want to have it there as a "safety net".

Deleted User wrote: »

The experts who come on the radio always advise at least to phone own insurance company and discuss what cover you want, and if remaining on same plan is best for you. I did this last year and a whole lot of plans were explained but to cut a long story short none of them would cover the stuff that I as a 60 year old with plenty of conditions would need. Got a knee replacement two years back and with the negotiation advised by them with hospital they agreed to take the amount offered from the cover without forking out.

Far too many people like me having joint replacements, and ironically as people do more running (not my thing) etc joints are getting worn down more quickly, and in younger people. They are going to cover less and less of these amounts. Too much keep fit can be costly, so advice might be to put aside a savings for potential future medical costs if you don't want to go in long public list, or to have it done in a country where it is cheaper if you don't have medical insurance, but bearing in mind one cannot fly back home until sufficiently healed.

Deleted User wrote: »

Knee replacement January 2018, on what was once called the old VHI Plan C Options. I phoned to check cover before op, VHI said there would be a shortfall but to phone Beacon & try & negotiate with them, which I did. They went through the patter that it wasn't normally covered but that they would do so on this occasion. I don't know on what criteria they agreed to make the exception. Maybe if I started quickly needing another joint done they'd refuse to cover the shortfall. I think it is an operating theatre cost rather than bed cost, because the VHI mumbled something about the fact that "high tech hospitals are not fully covered for orthopaedic procedures", and I asked them what hospital they considered "non high tech", and Vincent's Private was one such, although most private hospitals in Dublin area are apparently considered "high tech".

Had a major very big surgery in Beacon in 2016, a full colectomy with ileostomy, which they agreed to entirely cover at the outset. However I got a bill subsequently for ICU consultant fee, and VHI told me they weren't going to cover that, and in future I should phone them before agreeing to treatment in a private ICU. Now I was not very conscious at the time, needing resus etc, not in a position to take up a phone & negotiate etc. The bill I received was €8000, I firmly refused to pay it, and was let off. The consultant seems to have agreed to take less than what he wanted or else he negotiated a bit more than VHI were willing to pay him. My care required his close attention over 3 days.

Things keep changing, so what applied to me above may not apply anymore, it is really difficult to keep abreast of things. You might take out cover, thinking it is suitable, then you get sick and undergo a procedure or get emergency treatment only to be told that what has happened you is no longer covered. I don't think folk realise just how unpredictable and precarious medical insurance cover is. Ideally you need to have a little savings pot of about €10K to cover these shortfalls should you be surprised. And one must bear in mind that any hospital admission, even for an apparently minor procedure, can unexpectedly incur complications which medical insurance doesn't quite cover. Sepsis can just set in out of the blue. There are too many changing variables to always ensure you have the right cover at the right time. You are playing against an ever moving goal-post.

intothewest wrote: »

So not only have you to decipher the various shortfalls etc for all types of ailments, but if you do have to be admitted for something, you have to then enquire what the costs would be should you hit complications, as you did. There are stats of risks to anything, so someone has to to be unlucky and hit additional problems. Asking people to do that when they are being admitted to ICU is nuts. What you'll find happening is people masking ailments, leaving too early so they don't rack up a bigger bill. Modelling the States as you said. It's very depressing.

intothewest wrote: »

What happens in that scenario, where the terms of the policy change mid policy? Would they refuse a claim I wonder, or honour it based on when you entered the policy?

I am still waiting to receive the recordings of the calls we had with them, nor have I received the transcript of the online chat that I had with them, despite both being requested and being told the former was being sent to me about three weeks ago.