Health Insurance Health insurance and public hospitals.

Apologies in advance if this has already been done but the question arises for us now as we are reviewing health insurance option for the new year.

If I go to a public hospital either through A & E or to outpatients on referral by my G.P. the hospital will ask if I have health insurance.

Q1. Am I obliged to disclose whether or not I hold health insurance ?

Q2. If so, why ?

Q3. If I do hold health insurance and tell the public hospital are there any risks that I might end up paying charges out of my own pocket ?

In relation to Q3 what occurs to me is this. If I attend a public hospital as a public patient I will not have to pay charges for the service - except the A & E charge (if I have no referral letter from my G.P.) and the bed charge if I have to stay over.

However, is there any danger that if the hospital attendance produces a claim against a health insurance policy that there might be a shortfall if a policy does not cover 100% of the hospital charges?

Worded less awkwardly, could I find myself paying a shortfall because I have a health insurance policy where I would otherwise pay nothing if I was an uninsured public patient ?

You are not obliged to use your health ins, and so become a private patient.

If you do choose to use your health ins, and be a private patient, yes you may have to pay an excess, this depends on your policy cover.

An uninsured public patient pays just 100 AE fee and 75pn/max 750, but may have to wait for treatment.

I was advised by my insurer (in one of those agent meetings for the company) to divulge that you have HI but to say that as soon as you get your private ward bed you will sign the form.

elcato said:

I was advised by my insurer (in one of those agent meetings for the company) to divulge that you have HI but to say that as soon as you get your private ward bed you will sign the form.

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Thanks for that, you learn something new everyday!

Protocol said:

You are not obliged to use your health ins, and so become a private patient.

If you do choose to use your health ins, and be a private patient, yes you may have to pay an excess, this depends on your policy cover.

An uninsured public patient pays just 100 AE fee and 75pn/max 750, but may have to wait for treatment.

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There's no excess on any plan for public hospitals.

Is that true? That you can say Ill sign the forms when I get to my ward and thus have no A and E extras to pay?

DirectDevil said:

Apologies in advance if this has already been done but the question arises for us now as we are reviewing health insurance option for the new year.

However, is there any danger that if the hospital attendance produces a claim against a health insurance policy that there might be a shortfall if a policy does not cover 100% of the hospital charges?

Worded less awkwardly, could I find myself paying a shortfall because I have a health insurance policy where I would otherwise pay nothing if I was an uninsured public patient ?

Click to expand...

DirectDevil,

When your admitted to any public hospital as an insured patient, everything is covered by your insurer, all scans,medication,treatment, surgery etc is fully covered. No shortfalls or excesses apply to any public hospital.

What can happen is if you were admitted through A+E, as a declared insured patient, and had surgery which is all fully covered by the health insurance provider. If you had a follow on post surgical consultant visit, check up etc six weeks later, this visit would be private and payable upfront. Otherwise everything else is fully covered.

Snowyb

snowyb said:

DirectDevil,

When your admitted to any public hospital as an insured patient, everything is covered by your insurer, all scans,medication,treatment, surgery etc is fully covered. No shortfalls or excesses apply to any public hospital.

What can happen is if you were admitted through A+E, as a declared insured patient, and had surgery which is all fully covered by the health insurance provider. If you had a follow on post surgical consultant visit, check up etc six weeks later, this visit would be private and payable upfront. Otherwise everything else is fully covered.

Snowyb

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Thanks for that.

I had a situation a few years ago where my G.P. sent me directly to a public A & E with a referral letter.
They held me overnight.
I had to come back 4 weeks later for an MRI scan which was directly related to the original attendance at A & E. I then had to attend outpatients (OP) a few weeks later as a follow up.

No question of insurance arose and it was all done for nothing as a public patient. However, if I was putting the matter through health insurance the MRI scan and OP follow up have been charged to the company.
Would an MRI scan, as an OP, at a public hospital be covered without shortfall or excess ?

I could envisage a future scenario where public hospital cover could be trimmed with excesses and so on unless the insurers are prohibited from doing that.

Interesting.

So say your GP says you need a procedure done by consultant, and you chose to go private.

Procedure happens in public hosp, as private patient - no excess to pay.

Procedure happens in private hosp, with same consultant present - excess to pay.

He is another case:

I have health insurance with VHI.

I was referred to a public hospital for a colonoscopy and was giving an appointment quickly without mentioning of health insurance.

When I received my appointment letter there was also a letter to fill out with medical card or insurance details. I left this blank as I was attending a public hospital in the public system.

When I reported the reception with my letter I was asked why this was blank, when I ask was this not a public appointment, I was told yes, but if you do not give me your insurance details there will be a charge of €75.

When I told her I was with VHI, she said that okay I can find you on the system (must have a database of VHI customers) just sign here.

My question is should I have got the test on the public system free?
(Tax /prsi usc payer off course)


Regards,

Nope, public hospital charge is €75 per day to a max of €750.

Is that not the charge for an in patient?
This was a medical test !!

Did you have a colonoscopy? If so, it's a day case inpatient service

The next question is "how much do hospital charge VHI?"
Could it be best for VHI that their insured person pays and VHI reimburses the insured person?.