Health Insurance Question re pre existing conditions

[Monbretia]

Quick question re the rules on pre existing conditions which I felt I knew but after an appointment with a consultant who told me that I needed to check with Laya whether or not the procedure was covered as it predated the move to Laya. He said he had trouble in the past with this and that he felt it would not be covered if the patient had not been with Laya the required amount of time before this condition surfaced.

Now we are talking about a person who has had continuous health insurance for more years than I can remember, certainly in excess of 35 yrs, mainly with VHI originally but have switched about a bit in recent years for obvious reasons.

Is this just a Laya thing or is he just wrong?

 

[snowyb]

He's just making sure its covered, as sometimes people change plans and they could be upgrading from a lower plan.
The level of hospital cover in question may not be covered for 2 years.
If he goes ahead with the procedure and the health insurer doesn't pay up, he's depending on the patient to pay the bill.

He wouldn't know the patients health insurance history but he's avoiding a potential problem before it arises.
He probably says it to everyone.

Without knowing the hospital in question, or the procedure involved its hard to determine.
For example, if you are on a VHI plan with 80% orthopaedic cover and you switch to Laya with full cover.
You could be suffering on and off for a while before finally going for a hip replacement in a private hospital which might charge for
the 20% shortfall. This shortfall is 3000 approx. You might be with Laya for 1 year, with another year waiting to serve before full cover
would apply for a hip replacement. It would be classed as a pre-existing condition and a shortfall would apply.

I would say the consultant is preventing a problem by making sure a procedure is covered before going ahead.
He is putting the onus on the patient to confirm cover so he is sure there won't be a problem with payment down the road.

Snowyb

 

[Monbretia]

Thanks for the detailed reply, he wouldn't listen to my explanation as to why it would be covered! I understand what you are saying about the shortfalls etc and upgraded policies, neither would apply in this case as he has been on the same policy for past few years now and only change was to private room which just this year he passed the waiting period for.

It is not even an inpatient thing, just a day room procedure, very minor, think skin related!

I imagine he does say it to everyone but it was when I mentioned Laya that he honed in on them being difficult and dismissed my attempt to explain that I was confident it was covered, that kind of annoyed me more than anything!

It's only a few months since I had similar run in with another hospital where VHI were telling them a procedure on my grandson wasn't covered as pre existing, he's 3 and has been covered since birth but I had moved him around from Laya which he was free on for the first year, then to Glo (who have been taken over twice I think) and then to VHI, VHI could not find any record for him having previous cover, Irish Life who I think now have Glo couldn't find him either and thankfully I had one old piece of paper left referring to his previous policy having done a clear out of my files last year but missed it for some reason (so much for going paperless!) that they were able to find him with. Very stressful goings on when you get that call the Friday before a Monday surgery!