Health Insurance Consultant Double Charging

S

Sunny

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My wife brought my daughter to a consultant recently for a check up that she needs every couple of years. Previously I was with Laya but in the last year switched to VHI. When my wife went there, she was asked if she was still with Laya and said no and gave her VHI details. The receptionist said there would probably be a charge but to go ahead and she will confirm after the visit. When she came out, the receptionist said there would be a charge of €150 which my wife didn't question as she assumed the VHI didn't cover the whole amount. I wasn't sure when I heard but took it at face value as assumed the receptionist rang the VHI.
Yesterday I received a claims statement that the consultant accepted a payment of €228 from the VHI in full settlement of the procedure. This despite us having handed over €150 in cash. I rang the consultants office they said there was a mistake and that claim to the VHI should only have been made for the difference between 150 and 235 (the cost of the procedure) and that they will fix it. I pointed out that this wasn't the mistake. The mistake was that you charged us for a procedure that was fully covered under our insurance. We shouldn't of had to pay anything so you should have claimed the full amount from the VHI, not the 85 difference. I was quickly told someone will have to ring me back. Still waiting...

Just wondering if anyone heard of this before and the best way to tackle this? Keep at the consultant or tell the VHI and let them deal with it?
 
Sunny said:
My wife brought my daughter to a consultant recently for a check up that she needs every couple of years.
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huskerdu said:
contact the VHI special investigations unit
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If it were me I would not contact the special investigations unit until the consultant's office get back to you, follow it up with them if they don't. If you don't get a satisfactory reply then forewarn them that you will be contacting VHI. It could prove awkward if you have to deal with them every couple of years if you don't give them the opportunity to correct the problem first. If you have an e-mail address for them it might be a good idea to write and request a reply rather than just relying on phone calls.

If it were me I would also consider if it is possible to move to another consultant, that is if you get one with a good bedside manner and equally qualified. These two qualities are very important when its children you are dealing it. You don't want this type of unnecessary hassle on a regular basis.
 
Sue Ellen said:
If it were me I would not contact the special investigations unit until the consultant's office get back to you, follow it up with them if they don't. If you don't get a satisfactory reply then forewarn them that you will be contacting VHI. It could prove awkward if you have to deal with them every couple of years if you don't give them the opportunity to correct the problem first. If you have an e-mail address for them it might be a good idea to write and request a reply rather than just relying on phone calls.

If it were me I would also consider if it is possible to move to another consultant, that is if you get one with a good bedside manner and equally qualified. These two qualities are very important when its children you are dealing it. You don't want this type of unnecessary hassle on a regular basis.
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Yeah I don't think she was trying to pull a fast one. Just incompetence. I will give it until tomorrow until I consider contacting the VHI about it. Consultant herself is lovely. Just not sure what happened here. Very frustrating and I would never had known if I hadn't just opened the VHI claims statements as I have to admit, I sometimes don't.
 
SBarrett said:
Maybe someone in the VHI made a mistake by paying the full amount instead of a partial payment?
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Maybe but the statement is clear. It has procedure code, cost of procedure and then even states that the consultant has accepted this payment as full settlement for the cost of the procedure and therefore no shortfall. Usually the VHI are pretty sure about what percentage of any claim they will cover. If they didn't cover 100% of that procedure code, they would have mentioned it. But I won't rule it out.
 
I'd be insisting the consultant send you back a cheque for €150 seeing as VHI have covered the cost of the procedure. Don't involve VHI yet as if they claim the balance back you are left out of pocket unnecessarily.
 
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