Dispute over claim with VHI

kerbs

Registered User
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Hi- Just wondering if anyone can help with this? My husband put in a claim with VHI and they are saying he isnt covered, we have read the terms and conditions and disagree. Is there anywhere we can go with this? All I have seen so far is courts etc.. is there like an ombudsman for health?? Thanks a lot
 
Any use?

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Q How to make a complaint

If you wish to make a complaint about your private health insurer, you should first discuss it directly with your insurer. If you are unable to resolve your complaint, you may contact the Financial Services Ombudsman. The decision of the Financial Services Ombudsman is binding on all parties but when one party is dissatisfied with the decision, it may be appealed to the High Court. You also have a right of access to the courts in respect of disputes with insurers.
 
For the first time since I joined VHI 44 years ago I have recently heard a few people say they were not covered when they made a claim for ins cover.
Recently my son checked that his planned procedure was covered. The day before he was due to have the operation carried out his surgeon phoned to say the hospital was not covered.
He missed his appointment and had to reschedule his procedure. When he phoned VHI they said he was covered and he requested an explanation. His is waiting on their reply. In the past we have only had the best of dealings with them, including amazing treatment when abroad on holidays.
I hope you will pursue your claim. Keep us informed
Browtal
 
Hi- Just wondering if anyone can help with this? My husband put in a claim with VHI and they are saying he isnt covered, we have read the terms and conditions and disagree. Is there anywhere we can go with this? All I have seen so far is courts etc.. is there like an ombudsman for health?? Thanks a lot

why are they not covering it ? reason given ?
ombudsman contact details on member handbooks https://www.vhi.ie/pdf/about/termsofbusiness.pdf
 
Alternatively you may contact the Health Insurance Authority.

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How do I make a complaint about my private health insurer?

Phone: 1850 929 166


Another useful website;

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Phone; 1890 882 090

Snowyb
 
Alternatively you may contact the Health Insurance Authority.

[broken link removed]

How do I make a complaint about my private health insurer?

Phone: 1850 929 166
Strange - my earlier link to the HIA website says deal with the insurer and then the ombudsman but does not say to contact them (the HIA). Mixed messages...
 
Thanks for help

thanks a lot for that... Am going to ring the HIA this morning.. I was only able to find information on appealing to the courts, which seemed a bit heavy handed.
Essentialy my husband was with VHI for year, moved to Quinn when he lost his job but never had a break of cover as such (in fact the two overlapped for a week).
When he got a new job he went back to VHI - I have VHI through work for myself and the kids and we decided that was best.
After all this happened he developed a condition which required day surgery. VHI have said although the treatment was covered he is not covered but he was with VHI at the time. TBH I would just like an independent arbitrator to look at this - if we have to pay for it ourselves we will.
 
thanks a lot for that... Am going to ring the HIA this morning.. I was only able to find information on appealing to the courts, which seemed a bit heavy handed.
Essentialy my husband was with VHI for year, moved to Quinn when he lost his job but never had a break of cover as such (in fact the two overlapped for a week).
When he got a new job he went back to VHI - I have VHI through work for myself and the kids and we decided that was best.
After all this happened he developed a condition which required day surgery. VHI have said although the treatment was covered he is not covered but he was with VHI at the time. TBH I would just like an independent arbitrator to look at this - if we have to pay for it ourselves we will.

still a bit unclear, if he was insured with vhi for a year and transferred to Quinn, how long was he with Quinn before moving back to vhi ? have you told vhi about his time in quinn and get a letter from quinn confirming that dates insured with them. has he been insure for 5 years in tital without a break in cover ? why as the claim rejected ? what was on the refusal letter from vhi ? was it pre-existing ?
 
Was there a break in cover of more than 13 weeks ?

If this is the case he would have to reserve all waiting periods all over again. It sounds as if it was a preexisting condition ?.

Did he only switch back to VHI after 1st January ? If so VHI are making people serve waiting periods for all upgades in cover for new and preexisting conditions. Was it in the Beacon ? If they turned you down, they would give the actual reason to you.

Patrick
 
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