Advice on policy for 34y old F with bad knees?

Hi all, hoping someone might be able to offer advice. I'm a 34y old F and do not have an employer paying for health insurance benefits as I work as a consultant in the non-profit sector.

I have knee problems (on both knees) severe (Grade 4) patellar chondromalacia, or runner's knee for those who might be familiar. Basically my knee caps are grinding bone-on-bone in places because the cartilage tissue has all worn away. At only 34 I can't run, hike, and it's very painful to use stairs. I have had MRI scans and seen specialists (in IRE paid for out of pocket), and although they don't advise surgery immediately (options are limited), it is likely that surgery is in my future.

I moved to Ireland 3 years ago and realised that given my condition, private health insurance is probably a good idea - though I also realised I will have to wait 5 years for any treatment on my pre-existing condition. Last year (30/01/2018) I signed up for VHI Start Plan 250, without too much research. Now that it is time for renewal (and I've been told my current plan is no longer available), I am trying to do research to ensure I am getting the right plan but am finding it very, very confusing.

First, I am realising that VHI doesn't offer full orthopedic cover.. but Laya does.. so possibly I should switch providers?

I don't care about private or semi-private rooms. I simply want to start cover so that when my pre-existing waiting period is up, if my condition has progressed to the point that I am ready for full or partial knee-replacement surgeries (or any other orthopedic surgical procedures) I will be eligible to have this covered - and I would like treatment at the Sports Surgery Clinic in Santry to be an option.

I am generally otherwise a perfectly healthy individual, so don't have any other obvious needs for health insurance, though some cover for physio would be a bonus, but maybe not necessary.

I am also currently paying for dental cover through VHI (240e/yr) so if there was a plan that might integrate some form of dental coverage also (with better value?) that would be great. I know dental insurance is not common in IRE.. but having the plan makes me go regularly and not fear any news I might receive (need for filling, etc).

My last question is.. does anyone know whether I may have any option to get surgical treatment for my knees under the public system, without private health insurance? Are any options available to me through this path?

Any advice would be GREATLY appreciated. With hundreds of policy choices, I am completely lost.

Thanks!!

Regarding your knees - have you seen a chartered physiotherapist who deals with sports injuries? This condition can respond very well to exercises and taping and possibly orthotics.

POC said:

Regarding your knees - have you seen a chartered physiotherapist who deals with sports injuries? This condition can respond very well to exercises and taping and possibly orthotics.

Click to expand...

Thanks POC. Yes, I've seen many physiotherapists over the years, tried exercises, taping, knee brace, injections. Nothing significantly helped or slowed down deterioration. Not given up on alternative options (again noting it could be helpful to have a health insurance policy that includes physio), but want to set myself up with adequate insurance coverage so that surgical options are possible if this is the best path for staying mobile in the future.
Side note - if there is a forum, or other place I could be directed me for finding good a good physio (in Dublin) that is experienced with severe knee issues I'd appreciate the tip. I've spent so much money over the years and it has gotten me nowhere, so advice is always welcome (apologies to mods if going off topic inappropriately).

Still lost with insurance, so any tips for this still greatly appreciated. Thanks!!

Hi Wilson745,

Welcome to AAM. As you will have to wait 5 years before your pre-existing knee condition will be covered, I have chosen a plan that has
good day to day cover including physio visits, refund 30 euro per visit. There is good cover for gp visits, consultants, dental cover 150 euro per
year which may replace the need for seperate dental cover. Plan details as follows;

1. Precision 450 Create; price 916pa; all public hospitals, selected list of private hospitals covered including Santry Sports Clinic and some
hi-tech hospital cover, private hospital excess 450 per admission for surgery/treatment. Day case excess 125 per procedure in a private
hospital. Note; there is no excess to pay in any public hospital.
Good day to day cover on this plan, with a 1 euro excess which means you are in a refund position straight away.
NOTE; There is no waiting time to serve for day to day cover, allowable straight away.
5 Year waiting time applies for hospital treatement or surgery in respect of any pre-existing conditons, but any new illnesses arising will be
covered straight away in hospitals covered on the plan.

**Note; I would recommend this plan for the first 3 years of the 5 years waiting and for years 4 + 5 you can decide what plan you would like to be on in future years and you can review your position at that stage. For example, you may want to include hi-tech hospital cover at that stage as
an extra option. If you upgrade cover for year 4 + 5, you will have full cover for all hospitals starting off year 6.

An example of a full cover plan is Laya Simply Connect, price 1100pa.
Laya Simply Connect; price 1100pa; all public, private and 3 hi-tech hospitals covered, private/hi-tech hospital excess capped at 150 x 2 max
per year(regardless of how many admissions in a private or hi-tech hospital) day case excess 50 per procedure. No excess to pay in any
public hospital. Good day to day cover, 50% refund for gp, physio, dental etc. - subject to a max refund of 500 per year. (50% of 1000 = 500).

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Regards, Snowyb

Thanks so much Snowyb! This is super helpful and I will look into this right away. I can't imagine how I could figure this out or where to even get started without this advice.

One more quick question though - since I've already been on a plan (VHI Start Plan 250) for a year, when I switch to Laya, will the waiting period only be 4 years?

Thanks again!!!

Yes, your year with VHI will be included in the 5 years, so the waiting will be 4 years from now on.
Well spotted!

Snowyb