Health Insurance Laya not covering pre op covid tests costs

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Kilconleagirl

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I recently had to return to my surgeon in dublin for corrective surgery on a ear that had been operated years ago so i had to have a pre op covid test, as i live in kerry, i had the test done in the bons tralee 2 days before surgery saving me the trip to dublin twice. Anyway I lodged my laya claim for half the covid tests costs and have been told by a laya representative that my claim will be rejected as i should have had it done in the dublin hospital.

As the hospital in dublin is the only place that does the surgery and having saved myself a journey up and down to dublin for the test, i thought it was ok to do the test in kerry.

I thought common sense would prevail with laya, am i wrong in thinking the claim should be approved?

Your advice is appreciated
 
Common sense........never prevails..........
What was the exact reasoning they gave for not covering the test after you explained things?
 
I recently had surgery in the Blackrock Clinic in Dublin. I had to go for a pre op covid test a couple of says before surgery and this was covered with Laya. All I had to pay is my €50 excess and then I ended up being kept in overnight so another €100 for that.
 
Kilconleagirl said:
The reason was the dublin hospital should have done the test and recouped it as part of the surgery claim
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That seems to be worth appealing, and/or if your appeal fails, complaining to the Financial Services Ombudsman.

www.fspo.ie (need advice about making your complaint? Call our helpline on 01 567 7000)
 
Kilconleagirl said:
The reason was the dublin hospital should have done the test and recouped it as part of the surgery claim
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I am afraid this is likely correct. This is probably because Laya would consider the test as part of the Dublin hospital's inpatient claim. Therefore the test is probably being covered under the inpatient part of your policy on a direct payment basis with the hospital. However if you just get a test done and try to claim the cost back it's probably considered as an out patient claim or a day to day expense claim in your policy and viewed separately to the surgery altogether.

It's definitely not common sense and just a bureaucratic technicality.
 
Thanks shirazman, will definitely appeal this, got a call from the laya complaints dept even the representative felt it unfair but they have their terms and thats it. Just waiting on the final laya rejection letter letter before going to ombudsman. Thanks again all for your advice
 
Laya has covered cost of Wife's pre op tests for day cases in Mullingar St Francis. There has been no charge to the patient for this test at the hospital where the procedure is taking place. The fact that the pre Covid test was done at a different hospital seems to be the issue.
 
Cavanbhoy said:
Laya has covered cost of Wife's pre op tests for day cases in Mullingar St Francis. There has been no charge to the patient for this test at the hospital where the procedure is taking place. The fact that the pre Covid test was done at a different hospital seems to be the issue.
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Yea cavanboy, the procedure i had done is dublin is the only hospital in the country that does the procedure so it didn't make sense to go up 2 days beforehand for covid test, go down the road home and back up again, hospital was fine with this, just laya isn't.
 
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