Hi, my son is covered under Laya Simply Connect Plus, which I thought was a policy with good cover. I had done my due diligence, as far as I could, in terms of comparing against other policies. He is a toe walker and had both legs put into casts last week in the National Orthopaedic Hospital Cappagh as a day patient (he was in the day ward with all other patients public or private). He had his initial outpatient appointment with the private clinic at Temple Street. Prior to the procedure I had asked the consultant for the procedure code, but they said don’t worry it is in a public hospital and the consultant is covered under all insurances. My mistake, I know, for not insisting on getting the details.
I filled in the Laya Claim form on admission to the hospital. I had a bill on Tuesday from the hospital with no explanation of what it was for – it just says ‘self payers – intervention’. The value is €329 which matches their charge for private patients for a day case. I’ve asked them to send me a more detailed invoice and asked them to send me details of what, if anything, they were billing to Laya. I am waiting on a response. When I spoke with them, they had no details on procedure codes as they were awaiting the consultant's notes. They mentioned that maybe I got a bill because he also had injections into his calf muscles and that they ‘thought’ Laya doesn’t cover them, but they weren’t sure. I basically got a bill, but they don't know why!
Here is the interesting bit – I called Laya today to ask about all of this. The private clinic had given me some codes this morning that they think might be the codes for the procedures (but they said I need the hospital to confirm). Code 4263 for the injections and 3130 for the application of casts. Laya told me that they cover the injections (4263) but that they do not cover this procedure under any of their policies. They said none of their policies cover it. I am so shocked that such a simple procedure is not covered. The most annoying part is that my son will be having the casts taken off and re-applied every 2-3 weeks over the next 3 months, so many multiples of €329 will be invoiced to me. In fact, I’m waiting for the hospital to confirm if I’ll be liable for other charges too at each visit.
I see that other insurers give access to their ‘Schedule of Benefits’ where you can see all the procedure codes. I have requested this from Laya, but I am not sure they will send it on. How are we supposed to be sure how suitable our policies are without such documents? At least if we have access to these before renewals, we might be able to change insurers (especially if we know it is a couple of years before we might need a procedure). To be honest, with such a simple procedure as cast application I would not have even considered that it would be something Laya wouldn’t cover, especially in a public hospital. As my son may need this treatment again in a few years, I will have to look at changing insurer at next renewal.
I feel so let down by the whole system. He has had this problem since he was 3 and I was always given the same response “he will grow out of it” or “I’m treating other children who will never walk, your son’s issue is not serious”. So, for years I played along with the public system and now that he’s 12, hasn’t grown out of it and will soon start secondary I resorted to going the private route. Now I find myself having to pay for the procedures because he was referred to the hospital on a private waiting list and the insurance won’t cover it. I’m so mad with myself for not insisting years ago that he be put on a public waiting list for this procedure. I’m kind of just ranting here as I don’t think there is anything I can do about it. But maybe someone has experienced this where Laya does not cover cast application (procedure code 3130)?
I filled in the Laya Claim form on admission to the hospital. I had a bill on Tuesday from the hospital with no explanation of what it was for – it just says ‘self payers – intervention’. The value is €329 which matches their charge for private patients for a day case. I’ve asked them to send me a more detailed invoice and asked them to send me details of what, if anything, they were billing to Laya. I am waiting on a response. When I spoke with them, they had no details on procedure codes as they were awaiting the consultant's notes. They mentioned that maybe I got a bill because he also had injections into his calf muscles and that they ‘thought’ Laya doesn’t cover them, but they weren’t sure. I basically got a bill, but they don't know why!
Here is the interesting bit – I called Laya today to ask about all of this. The private clinic had given me some codes this morning that they think might be the codes for the procedures (but they said I need the hospital to confirm). Code 4263 for the injections and 3130 for the application of casts. Laya told me that they cover the injections (4263) but that they do not cover this procedure under any of their policies. They said none of their policies cover it. I am so shocked that such a simple procedure is not covered. The most annoying part is that my son will be having the casts taken off and re-applied every 2-3 weeks over the next 3 months, so many multiples of €329 will be invoiced to me. In fact, I’m waiting for the hospital to confirm if I’ll be liable for other charges too at each visit.
I see that other insurers give access to their ‘Schedule of Benefits’ where you can see all the procedure codes. I have requested this from Laya, but I am not sure they will send it on. How are we supposed to be sure how suitable our policies are without such documents? At least if we have access to these before renewals, we might be able to change insurers (especially if we know it is a couple of years before we might need a procedure). To be honest, with such a simple procedure as cast application I would not have even considered that it would be something Laya wouldn’t cover, especially in a public hospital. As my son may need this treatment again in a few years, I will have to look at changing insurer at next renewal.
I feel so let down by the whole system. He has had this problem since he was 3 and I was always given the same response “he will grow out of it” or “I’m treating other children who will never walk, your son’s issue is not serious”. So, for years I played along with the public system and now that he’s 12, hasn’t grown out of it and will soon start secondary I resorted to going the private route. Now I find myself having to pay for the procedures because he was referred to the hospital on a private waiting list and the insurance won’t cover it. I’m so mad with myself for not insisting years ago that he be put on a public waiting list for this procedure. I’m kind of just ranting here as I don’t think there is anything I can do about it. But maybe someone has experienced this where Laya does not cover cast application (procedure code 3130)?
