Healthcare costs - not insurance Public patient waiver form?

[StellaMaris]

I have a surgery scheduled for the Mater and even though I have a good health insurance plan due to possible complications the (private) consultant moved the surgery to the public hospital. The main procedure would be covered under my health insurance plan however they might attempt a 2nd unrelated procedure depending on how it goes which would not be covered. It is more like an “add on” ("while we are at it...") and would take 10-20 minutes while the main surgery will take a few hours.

I would prefer a private room and would be covered for it according to my plan. If I go public there will be a shortfall of 80 EUR/night but if I go private the hospital will charge the insurance 800 EUR/night. I will probably have to stay 3-5 days.

However due the possible 2nd procedure I am not sure if I should sign the public patient waiver form when being admitted to the hospital saying I want to be treated as a private patient? Not sure if they will even bill it separately as I am in the theater anyway but could this result in me having to pay a huge bill?
Or is the waiver only for the room charges and not for the procedures (cost for theater etc)?

And how likely is it that I would even be getting a private room in the Mater?

I really hope someone could give me some advice as I am really anxious with the surgery and would like to get clarification beforehand. I don't know who else to ask, the secretary of the consultant referred me to the hospital, the hospital to VHI and VHI was not able to help either...

 

[arbitron]

It is possible but very unlikely that you would get a private room in the Mater public. They are typically reserved for isolation (patients with infectious diseases) and for those who are dying. It's the luck of the draw on the day.

What are the 2 procedures involved? Did you get the VHI code numbers for each procedure?

 

[Starrynights]

Hi Stella,

When it comes to how procedures and stays are billed there a few options.

Under a public hospital:

Option 1, be treated as a public patient:
The fee is €80 a night capped at €800. This fee is waived if you have a medical card. VHI should cover this cost cost for you. It's known as a Public Hospital Statutory Levy. They should pay the hospital directly. To get this you need to sign a VHI form during the stay to authorise them to pay the hospital directly. This is not the public patient waiver form. Do not sign that form if you want VHI to only pay the levy.

Option 2 Be treated as a private patient in the public hospital:
Sign the public patient waiver form. Things are now pretty much exactly the same as being in the Mater Private from a billing perspective. You now shoulder all the ultimate responsibility for the bill ie. Any parts your insurer may dispute paying. The public hospital will now charge private rates for everything. A public ward or semi private ward bed will cost €800 a night instead of €80. A private room €1000 (as noted above almost impossible to get one just based on preference). All surgeries, tests etc itemised and billed for. Like in option 1 you will also likely sign a VHI form to authorise them to pay the hospital directly. It is of my opinion that you ask the hospital what you will be guaranteed (not just likely) to get by signing the waiver. If they can't guarantee you extra then it's likely you will get the exact same service but the bill to VHI will go from being a few hundred to many thousands.

In private hospitals:

Option 3 Get treated in a private hospital as a private patient:
Hospital choice depends on your insurance coverage. You are guaranteed at least a semi private ward. You are billed much the same way as in option 2.

You need to clarify all procedure codes with VHI. If they won't cover the second additional procedure and you are going to have it in a public hospital anyways due to need, I would give heavy consideration to option 1. Otherwise it might be useful to chase down the hospital for the cost of the bill for that procedure so you can see how much you might have to pay if insurance don't pay out in option 2. They will probably be reluctant to get you a proper figure but they have to because they need to quote people who choose to self pay without insurance.

 

[RetirementPlan]

Why is the second procedure not covered by insurance? This sounds like cherry picking by the private service, doing the easy, profitable work and expecting the public service to pick up the rest.

 

[StellaMaris]

It is possible but very unlikely that you would get a private room in the Mater public. They are typically reserved for isolation (patients with infectious diseases) and for those who are dying. It's the luck of the draw on the day.

What are the 2 procedures involved? Did you get the VHI code numbers for each procedure?

Thanks that's what I thought especially now with the Covid figures on the rise.
I did get the code for the main procedure but not for the 2nd one. However one of the consultants inquired on my behalf last year and VHI refused but this was as a stand alone procedure.

You need to clarify all procedure codes with VHI. If they won't cover the second additional procedure and you are going to have it in a public hospital anyways due to need, I would give heavy consideration to option 1. Otherwise it might be useful to chase down the hospital for the cost of the bill for that procedure so you can see how much you might have to pay if insurance don't pay out in option 2. They will probably be reluctant to get you a proper figure but they have to because they need to quote people who choose to self pay without insurance.

Thanks for the overview much appreciated!
Unfortunately Option 3 isn't an option because they already tried to do the procedure in a private hospital but had to abort during the surgery. It has been moved to the public because it will take longer and senior staff needs to be present. Also the ICU is better equipped in the public apparently. Not worried at all...
I always thought I have better treatment options in private care like advanced techniques and equipment etc. and I am still confused that it doesn't seem to be the case.

These are good points a) to ask the hospital what will be guaranteed and b) to request the exact costs for the 2nd procedure beforehand in case I have to pay myself. I will try to get this sorted beforehand as I know I will be too overwhelmed on the day and might not be able to make quick decisions.

Why is the second procedure not covered by insurance? This sounds like cherry picking by the private service, doing the easy, profitable work and expecting the public service to pick up the rest.

The 2nd procedure is a reversal of a surgery done over 20 years ago abroad so they refuse to cover it. Not sure though why it is not covered after 5 years even if it is a pre-existing condition and I am with VHI 15 years now... Maybe worth looking into it as well.

 

[RetirementPlan]

The 2nd procedure is a reversal of a surgery done over 20 years ago abroad so they refuse to cover it. Not sure though why it is not covered after 5 years even if it is a pre-existing condition and I am with VHI 15 years now... Maybe worth looking into it as well.

Feel free to ignore me or tell me to go away if I'm intruding, but is it deemed medically necessary, or is it cosmetic or similar?

And a more general question to all - is there any element of the consultant skipping the queue to get facilities in the public hospital here?

 

[Curlyfella]

Thanks that's what I thought especially now with the Covid figures on the rise.
I did get the code for the main procedure but not for the 2nd one. However one of the consultants inquired on my behalf last year and VHI refused but this was as a stand alone procedure.


Thanks for the overview much appreciated!
Unfortunately Option 3 isn't an option because they already tried to do the procedure in a private hospital but had to abort during the surgery. It has been moved to the public because it will take longer and senior staff needs to be present. Also the ICU is better equipped in the public apparently. Not worried at all...
I always thought I have better treatment options in private care like advanced techniques and equipment etc. and I am still confused that it doesn't seem to be the case.

These are good points a) to ask the hospital what will be guaranteed and b) to request the exact costs for the 2nd procedure beforehand in case I have to pay myself. I will try to get this sorted beforehand as I know I will be too overwhelmed on the day and might not be able to make quick decisions.



The 2nd procedure is a reversal of a surgery done over 20 years ago abroad so they refuse to cover it. Not sure though why it is not covered after 5 years even if it is a pre-existing condition and I am with VHI 15 years now... Maybe worth looking into it as well.

Why won't they cover the reversal?
You should be covered if it is a medical issue, regardless of where it was done