Health Insurance Claiming benefits from LAYA

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elacsaplau

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I've been told by LAYA that I can claim benefits within 12 months of the date of payment.

I was surprised by this but to be fair that's what it says on their website also.

Why I'm surprised is that I'm almost certain that previously payments in the previous policy year were reimbursable.

If I have this right, it's a pretty significant change in benefit terms. When did this change happen and were policyholders advised about this? I'd be surprised if this was clearly brought to my attention.....maybe it was buried in the small print of the renewal docentation?
 
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With the app now I submit expenses as I get them, previously I would have sent them all in in January for the entirety of the previous year.

Previous policy year seemed much fairer on the customer while still preventing a backlog for Laya.
 
Thanks guys.

I'm travelling today so don't have access to my health expenses file but the 2017 date (even with the 12 moratorium) surprises me as I'm almost certain that I did a return in 2019 and went back more than the strict 12 months being mentioned now?
 
My renewal notice in October 2017 contained the following, so my reading is I could have claimed older expenses up to 12 months after they notified me ( I.e. the 12 month moratorium only started on your first renewal after their announcement).

"From your renewal, we will be implementing an existing rule which states that out-patient claims should be submitted within 12 months of the treatment date on your receipt. In order to help you with this transition, we
will pay out-patient benefits for any receipts that you have not previously submitted if you send them to us within the next 12 months."
 
I knew there was a time limit but never looked into it as we're like odyssey06 as soon as we have a medical expense that is claimable it gets submitted through the app and normally reimbursed within a few days
 
I think the threads outlined so far on the above topic just show how confused customers are with Laya when making a claim for everyday medical expenses.

The reality is that there is a conflict between what Laya are stating on their website and also their outpatient claim form regarding how far back you can go to claim medical expenses, to what the Laya app states and also what Laya have confirmed to me on several occasions when challenged.

Their website states - Claims must be submitted within 12 months of the treatment date on your receipt.
Click to expand...

Their outpatient claim form also states " Claims must be submitted within 12 months of the treatment date on your receipt.

However the Laya app states- Members can claim on receipts once they are submitted within 12 months of your renewal date. If receipts aren't submitted within this timeframe, your claim will not be paid.
Click to expand...

So, there is a big difference between the two definitions, yet Laya are referring to the exact same subject. Even the Laya app is not totally clear how far back you can claim but it is closer to the reality. Two separate staff members confirmed to me when challenged that there is clearly a difference in meaning as outlined in their website as compared to their app. When I asked one staff member is their website inaccurate-they replied yes and they will get this changed. When I checked their website today, it is still giving the same terminology as quoted above.

The rule as confirmed to me by Laya after challenging them on their original misinformation is as follows;

THE RULE CONFIRMED TO ME IS THAT YOU GO BACK TO THE LAST RENEWAL DATE ON YOUR POLICY- YOU THEN GO BACK 12 MONTHS FROM THAT LAST RENEWAL DATE AND THAT GIVES THE MEMBER THE EARLIEST DATE HE/SHE CAN CLAIM HIS MEDICAL EXPENSES.

Lets look at examples to understand this better.


Example 1- Lets say the member has the normal calender year as his policy term. So we are now in 6th Nov 2021. His last renewal date was 1st Jan 2021, so he can go back 12 months to 1st Jan 2020 to claim his everyday medical expenses.

So you can see even from this example, that he could have a doctors bill on the 2nd Jan 2020, which he can still claim today, even though the doctor receipt is way beyond 12 months (which conflicts with Laya's website definition). So in this case, once he submits all his bills for 2020, he can claim these before 31st Dec 2021.


Example 2 - The same member as example 1, but this time he wants to claim for a doctors bill dated 29th Dec 2019.

You apply the same process as example 1, but as the furthest you can go back is the 1st Jan 2020, then it falls out by
just two days so no claim can be made.


Example 3 - Lets say the member has a member has the renewal date of 1st October as his policy term start date. So we are now in 6th Nov 2021. His last renewal date was 1st Oct 2021, so he can go back 12 months to 1st Oct 2020 to claim his everyday medical expenses.

The key point to remember is that if your renewal date was only a few weeks ago, like in this example then you only go back 12 months from the last renewal date.



I hope the above explains the correct way to claim Laya medical everyday exps.

I think its incredible that their staff and also their website are giving out the incorrect information when claiming expenses. As can be seen from the examples outlined, there can in many cases be well over 12 months from the date of the receipt that a member can still be entitled to claim their expenses. This is clearly at odds with the website definition as outlined above.

I think its also incredible that their website is incorrect on this topic and even when I pointed out this error this still hasn't changed.

I wonder how much medical expenses should have been reimbursed to customers and through misinformation have not been claimed and now possibly cant be claimed?
 
Ah, there is indeed a conflict in their wording.
Here's the wording from my latest policy rules (a month ago!)

"
(c) You should send your claims to us as soon as
possible through the Member App or using
an out-patient claim form. We will not pay for
any benefits unless:
• you submit your receipts to us within
twelve months from the end of your policy
year. If your receipts are not received
within this timeframe, your benefits will
not be paid."
 
Hi Red Onion.

Thanks for your thread. That confirms my understanding.

As can now be clearly demonstrated, the website is wrong and misleading.

Do members have any claim now (excuse the pun) , if they have been given the wrong info either by phone or through the website?
 
I smelt something wasn't quite right with what I had been told by LAYA - hence why I started this thread.

There's something in me that likes getting to the bottom of things (pig-ironess perhaps) but, armed with my newly acquired knowledge thanks to this thread, I decided to ring LAYA this morning and posed the same question that I had asked the other day.

I was speaking with a different agent but again got the wrong info that a strict 12 month period, from the date of the expense, applied.

I asked her to explain what the clause that Red Onion had quoted meant.....to which I got a "can you please hold the line?" followed by an "I spoke to my supervisor and it's not actually 12 months from today's date, etc., etc.:"

It seems to me that LAYA is happy to have misinformation on its website and for its agents to be pretty clueless in this specific regard.

When the misinformation is as systemic as this to the detriment of its customers and where it has not been fixed within a reasonable timescale (as is clear from Gregmill's post), then I believe that it is fair to go as far as to say that we are in insurance questionable behaviour territory.

One for Fierce Doherty perhaps?
 
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Following on from the last thread, you could hardly say Laya "is looking after you always".

The question i would put to the politicians - is there any regulation in relation to the health insurance sector?

If there is, there would appear to be deficiencies in this regulation, if this behaviour is allowed to continue.

If so, how can companies like this give out false information, which is obviously misleading
to its customers and face no consequences.
 
I was of the belief it was 12 months from date on receipt and I believe I has a claim rejected about 2 years ago because I was out of time. I wonder if I can get redress. I had this faint back of my mind push to get this years receipts in before it is too late and now maybe I am able to give myself a break as I normally like to do this in January along with tax rebate on medical expenses.
 
Regarding the last post, I would imagine it all depends on what was the basis of your claim been rejected. If it was rejected because you submitted your receipts late because you were late per their rules, then you may have no case.

However, if your claim was rejected because they gave you the incorrect information over the phone or indeed you relied on their website, then perhaps you might have a claim.

I spoke to a solicitor friend of mine last night regarding the items mentioned on the above threads and basically explained to him that we have a very large company in the health insurance business not being honest with its customers with regard to how far back a member can claim regarding their everyday medical expenses. (refer to previous threads)

He explained to me that this should be reported to the Financial Regulator, but in his opinion I could be wasting my time as in his dealings with them in the past, he found them to be useless.

This reminds me of the Tracker mortgages debacle, is this another mess that the ordinary person has to fight a large conglomerate to get fair play?
 
We've been a member of Bupa, Quinn and now Laya since 2002, since AIG took over Laya the rules have gotten tighter and tighter and like most here have had out patient and other medical costs rejected due to time, which I think only came in 2016/17....without any explanation.

However when I was sick they paid all my hospital costs years after I got sick, in 2015 I got pneumonia and was laid up in hospital for 2 weeks, I got the statement in 2018 telling me that they were delighted to inform me that they settled my hospital costs.

Again it's the ordinary joe that is targeted in this, our Gross premiums are over 9k for 2 in our 50s and 2 young adults and we have all the bells and whistles, its actually uneconomic but we have to have it.
 
In relation to the last post, health insurance is very expensive for the ordinary Joe but as you say the average family needs to have health insurance even if it is a huge burden on their finances.

As you say, its a very expensive cost to most families, that's why its even more frustrating when you get a company that makes it difficult to claim everyday medical expenses by giving misinformation through its website and its staff.

There could be thousands of families out there, who didn't claim their everyday medical expenses from Laya because

A) They were told over the phone that you could only claim back within 12 months from date of treatment or

B) They relied on the Laya website , which basically said the same as A above.

As stated in earlier posts the statement regarding 12 month from date of treatment is incorrect and totally misleading.

The reality may have been, that these Laya members possibly could have at a certain point in time, still been able to claim back their expenses for a certain period, but through misinformation given by Laya as outlined above were mistakenly unaware that they could have still had time to make a genuine claim.

This is indeed a sad state of affairs and if anyone does the maths, one could be talking about a large sum of money.
 
Just a reminder to all Laya customers if your policy year was the calendar year 2020 ie., it finishes on the 31st Dec each year, then you can claim your 2020 everyday medical expenses using their app right up until 31st Dec 2021.

Laya will probably tell you the following if you contact them directly ;

“You can only claim medical expenses for only year from the date of treatment”

Their website will state the same, but this is also incorrect.

Refer to “Red Onion” post above and this is the correct wording of the contract.

My advice is claim the medical expenses if the above applies and you might get an extra Christmas present if you claim your expenses on time.
 
Paul O Mahoney said:
We've been a member of Bupa, Quinn and now Laya since 2002, since AIG took over Laya the rules have gotten tighter and tighter and like most here have had out patient and other medical costs rejected due to time, which I think only came in 2016/17....without any explanation.

However when I was sick they paid all my hospital costs years after I got sick, in 2015 I got pneumonia and was laid up in hospital for 2 weeks, I got the statement in 2018 telling me that they were delighted to inform me that they settled my hospital costs.

Again it's the ordinary joe that is targeted in this, our Gross premiums are over 9k for 2 in our 50s and 2 young adults and we have all the bells and whistles, its actually uneconomic but we have to have it.
Click to expand...
3 years to process your hospital bills seems like an awfully long time. I think it might be vastly improved these days.

When you say 9K gross, I presume you mean before the 20% tax back is applied to the premium? That's still 7200 which sounds like a lot for 4 people, especially considering young adult rates should be fairly discounted. In my opinion if anyone is paying more than 1500 net per adult (significantly less per young adult) you should take a careful look at the cost effectiveness of your current plan and compare to the alternative options, especially the corporate plans offered by insurers. You can often save a lot by taking on a bit of excess and accepting a semi private room in private hospitals ( private rooms are not guaranteed even if covered by your plan and are often given based on need rather than cover. This means even if you have only semi private cover, if you need a private room for medical reasons or they are the only beds left you'll be given it for free as long as you don't request it ie.specifically state you want a semi private room as you don't want to be charged out of cover costs.)
A good place to see some of the current top plans is the total health cover special offers page. https://www.totalhealthcover.ie/special_offers.
 
Hi Starrynights

This thread is not about the cost of different plans regarding health insurance, which is indeed a very complex issue for customers, it seems to relate specifically to claiming everyday medical expenses on all plans from Laya and their rules governing this.

Someone informed me that on their website last week their alleged policy was that your submitted claim must be made within " 12 months of the treatment date on your receipt". (which we know was incorrect but was on the Laya website for the past number of years)

Then, in the last few days I was informed that they have changed their website to the correct wording as per the policy document that agrees with the post from RED Onion above.

We will not pay for
any benefits unless:
• you submit your receipts to us within
twelve months from the end of your policy
year. If your receipts are not received
within this timeframe, your benefits will
not be paid."



THIS IS VERY INTERESTING, HOW MANY CLAIMS DID THEY DENY THAT SHOULD HAVE BEEN PAID BECAUSE CUSTOMERS WERE MISINFORMED????
 
Gregmill said:
THIS IS VERY INTERESTING, HOW MANY CLAIMS DID THEY DENY THAT SHOULD HAVE BEEN PAID BECAUSE CUSTOMERS WERE MISINFORMED????
Click to expand...

Hi Gregmill,

Well, if the Regulator wasn't so rudderless, they'd be asking that very question....
I wouldn't be holding my breath though.

Given my experience with them, I can't imagine LAYA voluntarily doing the right thing given its culture.
 
elacsaplau said:
Hi Gregmill,

Well, if the Regulator wasn't so rudderless, they'd be asking that very question....
I wouldn't be holding my breath though.

Given my experience with them, I can't imagine LAYA voluntarily doing the right thing given its culture.
Click to expand...
I recently had a hospital admission in Tenerife. Following a bad fall I was admitted to a hospital with suspected heart failure. This condition was later confirmed.
I phoned Laya, as they instruct members to do. I told them I was in emergency department with chest pain.
They asked me to get the doctor and get an estimate for the proposed treatment. I was outraged and told him
That was his job, I was concerned about my health and had no intention of following his instructions.
I paid €2,000 to be admitted to a bed, otherwise treatment could not be carried out.
The time was then 3 am. It was after 4 pm before treatment was sanctioned by Laya.
This incident was in Marked contrast to Vhi a few years earlier when my husband had a hospital admission to the same hospital
. He was treated immediately, Whi kept me informed daily about treatment and plan for the coming day.
Their support was amazing.
Laya abandoned me, I explained that I was on holiday on my own and needed back up. Laya did not care.
Had I needed urgent treatment, they had no service during the night. The agency I contacted told me that LAYA office did not open until 9 am. If my condition was life threatening I was not about to have treatment until they sanctioned it 13 hours later.
I was lucky to have travel insurance who immediately offered any assistance needed. They were most supportive and helpful. Laya Did Not Care. How can a hospital give an estimate for treatment when a person is admitted for emergency care for chest pain.
Beware. I wrote to Laya more than two weeks ago for an explanation but to date have not heard from them.
They are supposed to be Looking After Me Always. Not a positive experience.
Any other Laya members have similar experience.
 
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