Laya Shortfall for private room?

[elirus]

Hi,
Just looking for some advice if anyone can offer any.
I took my child through A+E last week, and we were admitted then for a 5 night stay. We were only asked if we had a medical card (which we don't), but weren't asked about health cover at any point, and it didn't occur to me to ask about it at the time.

Once we were brought in we were put into a private room. There was space on the public ward, but due to the nature of the condition we were there with, monitoring needed to be done in a private room. We stayed 3 nights in there, and on the 4th morning we were told we needed to be moved to the public ward to make room for someone who needed to be isolated. So no problem, we moved (condition had improved by then so didn't need the same level of monitoring). We then spent 2 nights on the public ward before being discharged.

So I've just received a bill in the post, €400 for the 5 nights (as a public patient). Our cover is with Laya, Essential Connect, which states that they cover up to semi private (not available in our hospital), and if you have a private room, a shortfall will have to be paid.

So now I need to decide whether to contact the hospital with insurer details or pay the €400 myself. Since I never asked for a private room, will I still be liable for paying a shortfall if I use the health cover? Can Laya dispute the private room with them since I didn't ask for it? Or alternatively if Laya are billed for the private room, does anyone know what kind of shortfall we're talking about per night? I have a feeling it would just be cheaper to pay the €400. And I don't know if I can phone Laya to ask them this, in case they take my phone call as a commitment to processing the claim with them?

I would really appreciate any advice anyone has, thanks.

 

[Sunny]

Interesting case. If it was a public hospital I think there is €55 per night shortfall on the Laya essential plan so it would be better for you to claim off the insurance.

The mad thing is that hospital will then turn around and charge the insurance company €5000 for the bed. (Private room v multi occupancy doesn't make that much difference in price would you believe) Crazy system. Ring Laya. There is nothing they can do until you actually claim. They might just tell you to pay the 400 and they will pay you the difference. A lot cheaper for them!

 

[POC]

You didn't use your health insurance, you were treated as a public patient. Ring Laya. I think they will cover the public patient charge for you. I have definitely done this before with VHI, when my child was in Temple St as a public patient.
Perhaps you have an excess on your policy? But it's probably less than €400.
Ring Laya and enquire.

 

[Mexicola]

You didn't use your health insurance, you were treated as a public patient. Ring Laya. I think they will cover the public patient charge for you. I have definitely done this before with VHI, when my child was in Temple St as a public patient.
Perhaps you have an excess on your policy? But it's probably less than €400.
Ring Laya and enquire.

Pay it yourself (public hospital carge)and claim it back from Laya. They'll pay it. No excess applies in public hospitals.

 

[elirus]

Thanks for the replies. I was of the understanding that I can't just pay it and then have Laya refund me, that they would have to be billed by the hospital themselves.

I'll give them a call anyway and see what they say. Thanks.