Laya Partially participating Hospital Consultants

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sick sean

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Can someone explain to me how a Consultant you have been attending for 6/7 years, decides they are now only partially participating with your private health insurer and nobody, Consultant or private health insurer informed the patient. Last year this flaw cost me over 800 euro covering the shortfall. This year tried to change Consultant to fully participating Consultant, but he declined to take on any new patients.
All these consultants work in both public and private hospitals. Thinking now of just going public and take my chances!
 
How do you find out who is a fully participating consultant? Did you have to phone around? Shocking that the consultant would do this after that length of time attending the same person/ or that your insurer would do this - whichever is responsible. I noticed myself on a recent in-patient claim form that my consultants fee had more than doubled to the previous time I had the procedure a year previously but I was covered as he accepted the insurer payment TG
 
I found out last year, a certain condition occurred that needed surgery. wife rang Laya to saying I was going in for a day procedure under Dr ????. She was informed that he was now only Partially participating with Laya and we would be billed for the balance of the bill which turned out to be in excess of 800 euro of the total bill. Hospital bed, radiography, labs and anaesthesia all covered but the consultant doesn't accept their(Laya) agreeded fees in full so you are charged for the balance. So in my opinion the consultant are paid by the state, they are paid by Laya and they are paid by the patient. Seems greedy to me as they using the Public hospital facilities.
 
Hi sick sean, are you attending the consultant in a public hospital or a private hospital?
 
sick sean,

While it is of no use to you now, there is a facility on the Laya website to check out if a consultant is fully participating or partially participating with Laya and it also shows a list of hospitals(including public,private and hi-tech) each consultant works from.
It may be useful for other readers or for future reference. It comes under the heading 'Members' and you choose 'Hospitals you're covered in' from the drop down menu. Then click on the pink heading entitled 'Consultants, GP and Dentists'. I find if you just type in the surname of the consultant and the county and submit, it works better. A list of say Dr Murphys shows up, from which you can click on your particular consultant. It will state whether they are fully participating or partially participating with Laya and a list of relevant hospitals attached.

Regarding your own consultant, you could make enquiries with the alternative health providers, VHI and Irish Life to see if he/she is fully participating with them. This may be an option worth exploring for your next renewal date. Its a right stickler of a situation to find yourself in
when your preparing for a hospital procedure. Its the last thing you need on your plate, having taken out health insurance to cover these events,
only to find out at the last minute, through no fault of your own, you are not fully covered for something that was fully covered on previous
occasions.

This is the kind of issue that should be brought to the attention of the Central Bank regulator or the Ombudsman. From the point of view of highlighting the lack of notice or information given to existing patients from Laya or the consultant. It is not satisfactory to be landed with a bill out of the blue for something that was always fully covered.
You could query this issue with the Health Insurance Authority to see what light they can throw on it.

I would be wondering also if you found out for example that the consultant was fully participating with VHI and you decided to switch at your
next renewal date, would this be treated as an upgrade in cover and would a 2 year waiting time apply for this consultant. The HIA should be
able to advise you accordingly.

Thanks for highlighting this situation, its an eye opener to say the least.

Snowyb
 
snowyb said:
sick sean,


I would be wondering also if you found out for example that the consultant was fully participating with VHI and you decided to switch at your
next renewal date, would this be treated as an upgrade in cover and would a 2 year waiting time apply for this consultant.


Snowyb
Click to expand...

Vhi will apply waiting periods, ILH will not apply them.
 
Thanks for the info Snowyb. Have been looking into the VHI and yes this consultant is fully participating with them but I'm not interested if they are going to apply waiting periods. Did query it with Laya at time of renewal in case this consultant was participating in better more expensive plans, was told even if I had their Rolls-Royce plan this consultant wouldn't be participating. Health Insurance is such a mine field and then they keep changing the goal posts!
 
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