Short story: I went for an ophthalmic appointment in the Wellington Clinic in the Beacon Sandyford. Fee was 300 Euros which included quite a few tests and a consultation. I submitted an outpatients claim to LAYA, the cover is normally for 50% of the fee - they decided to pay 125 as "We have allowed up to the amount that is considered to be reasonable & customary as per the laya healthcare Scheme rules & table of benefits." This term does exist within the LAYA documents, they saved themselves 25 euro but have left a somewhat bad taste in my mouth as a customer. I do get the reasonability aspect, but to apply it where extensive tests were carried out seems odd and given they saved 25 quid hardly seemed to warrant all the effort that went into it. thru took three weeks to get back to me.