Health Insurance "Should you declare as a private patient in a public hospital?"

[Brendan Burgess]

Analysis by Fiona Redden in the Irish Times

Should you declare as a private patient when attending a public hospital?


“Nothing will change [if you declare as a private patient attending A&E] – you’ll have the same bed,” says Goode, arguing instead that people should be aware that they are entitled to say they don’t want to sign the form.

“Be very, very careful –– make sure you’re getting something extra. In most cases you won’t if you’ve gone in as a public patient,” he says, suggesting that PHI patients first ask whether or not a private room is available before signing the form.

And opting to stay as a public patient doesn’t mean you can’t switch to a private patient at some point in the future. “You can always skip tracks if you want to,” says Goode.

If, for example, you are discharged from hospital but you find that you still have issues, if you attend a consultant and they refer you to hospital again, this time you will be entering from the outset as a private patient, and the issue won’t arise."

 

[Sophrosyne]

There is certainly no medical advantage to being a private patient if one presents in A & E with a serious illness.

 

[Masque]

When you are admitted as an inpatient, my advise to readers is only sign the medical insurance form if you are availing of the benefits of such insurance, such as a semi private or private room. Once you are admitted ( other than pregnancy ) there is no difference as to how you are treated between being a public or private patient within a public hospital. Dermot Jewel discussed this very matter on a radio programme some time ago.

 

[michaelm]

There is certainly no medical advantage to being a private patient if one presents in A & E with a serious illness.

Is there a disadvantage? I would always present as a private patient.

When you are admitted as an inpatient, my advise to readers is only sign the medical insurance form if you are availing of the benefits of such insurance, such as a semi private or private room. Once you are admitted ( other than pregnancy ) there is no difference as to how you are treated between being a public or private patient within a public hospital.

If you present as a public patient and are admitted will your health insurance still pay the €75 per night hospital charge? I can't fathom why some with insurance don't just take a belt and braces approach, just sign and work on.

 

[maryburry]

The last time I went to A and E. The girl at the desk just said 'oh I see you've vhi. Do you still have it'. So had I been admitted I assume I'd have had no choice but to be private. Couldn't there be extra charges at a and e stage if you're private and your sent for tests like ct or MRI as they're not covered in your plan and you're not yet admitted?

 

[demoivre]

If you declare as a private patient in a public hospital you're stay will probably be longer as the hospital will be more than happy to gouge the health insurance company !

 

[trasneoir]

Is there a disadvantage?

It's bad consumerism. If you were offered two prices for the same room - €75 a night or €813 for the same room, which would you choose? Bad consumers make bad businesses.

If hospitals are selling basic services to the public insurer below cost, and getting private money to subsidize the discount by paying 1000% more for the same services, won't this allow the public insurer to be systematically underfunded?

As an electorate, we've chosen a public healthcare model, and this seems like a subtle but really significant erosion of that ideal.

 

[michaelm]

If you were offered two prices for the same room - €75 a night or €813 for the same room, which would you choose?

It's not the same room. It's either a private room or semi-private ward verses a public ward.

The health insurers still turn a profit. Public hospitals will get the money from insures one way or another, if they need to charge more for 'genuine' private patients to make the numbers add up then I suppose they'll do that . . either way, ultimately, I don't think it will make much difference to premiums.

 

[Masque]

It's not the same room. It's either a private room or semi-private ward verses a public ward.

The health insurers still turn a profit. Public hospitals will get the money from insures one way or another, if they need to charge more for 'genuine' private patients to make the numbers add up then I suppose they'll do that . . either way, ultimately, I don't think it will make much difference to premiums.

I am afraid there are many instances that once the patient has signed the private health insurance documentation produced to them, they end up in a public ward ( usual excuse is that there are no private beds currently available ) The private health insurance provider gets hit with a bill for a private room eventhough patient is in a public ward, thus inflating the price of private health insurance cover for consumers. This has been going on for decades. Once again I will reiterate that once you become an inpatient in a public hospital there is no difference in the standard of medical care that both public and private patients receive.

 

[monagt]

I am afraid there are many instances that once the patient has signed the private health insurance documentation produced to them, they end up in a public ward ( usual excuse is that there are no private beds currently available ) The private health insurance provider gets hit with a bill for a private room eventhough patient is in a public ward, thus inflating the price of private health insurance cover for consumers. This has been going on for decades. Once again I will reiterate that once you become an inpatient in a public hospital there is no difference in the standard of medical care that both public and private patients receive.

It was brought in to charge on the double...........if you are entitled to a bed without private insurance - don't answer as its none of their business unless you request a priv/sem priv room

 

[trasneoir]

It's not the same room. It's either a private room or semi-private ward verses a public ward.

In the context of this thread, we're talking about private insurance (over)paying to put their customers in public beds, because the private beds are full.

 

[michaelm]

I am afraid there are many instances that once the patient has signed the private health insurance documentation produced to them, they end up in a public ward

To be fair, this did happen on one occasion to a relative of mine who was admitted to hospital many times over a three year period, although they were moved to a private room on the second day. It hasn't happened to anyone else I know. I suspect that it may be an infrequent occurrence.

 

[riya99]

But, if you don't declare your private insurance, can you subsequently recoup the €75 per night charge from your health insurer?

 

[Gordon Gekko]

I just spoke with someone who deals with this stuff on a day to day basis.

She said that patients with private health insurance are only charged extra if they're in private or single rooms.

On that basis, where's the upside in hiding the fact that you have insurance?

 

[becky]

Public hospitals staff are expected to ensure that they receive the maximum income possible. If you are admitted via the Emergency Department, staff are instructed to ask if you have PHI. If you declare you have PHI and are allotted private/semi private room, the hospital will receive the income, if you are not allotted a private/semi private room, the hospital will not receive anything.

My elderly Dad has been admitted 3 times in the last two years. On two occasions he was in a private room, he doesn't have PHI and we didn't ask for a private room. On his last admission we didn't feel a private room was necessary and said so to staff. We were advised that it was a clinical decision but for want of a better word,it was also the luck of the draw, ie: there was a private room available at the time of admission. They advised us that other patients who had also been flagged as requiring a private room did not get one as there wasn't one free at the time.

I have PHI but it's not for a private room, it's for access to consultants if I need a consultation. If I am admitted via the ED I want to be treated so that I get better and go home. I really don't care where in the hospital that happens.

 

[maryburry]

But can someone tell me if you declare as phi going in through ED and you have a range of ct, mri etc.done prior to being admitted to a bed are you then charged for theses tests as you weren't actually an in -patient when they were done?

 

[Bronco Lane]

My father was admitted to a hospital and put in a public ward despite having VHI. They did some tests and discovered that he had MRSA. He was immediately put in a private room.

 

[Gordon Gekko]

That had nothing to do with having private health insurance though.

But they probably charged based on him being a private patient.

 

[Joe90]

I recently went through chemotherapy as a public patient, and developed sepsis after coming home, was public patient throughout the whole pre-care and 5-day chemo course. Had to be admitted to isolation room in the Lourdes Drogheda, and spent 10 days in a private room last cleaned by Mother Mary Martin herself, and sharing a toilet with two ladies in an adjoining semi-private room. A week after I came home, received private insurance claim letter, they wanted to charge my insurer €1,000.00 per night for the kip! I never requested private treatment access, and certainly do not recall signing any request to be admitted as a private patient. Neutropenic sepsis can only be managed in an isolated environment, whether public or private. Are they submitting claims as a matter of course for isolated patients if they know you have cover?

I disputed the claim with the hospital, and reluctantly completed the claim form. My insurer has not been in touch since the claim form went in. If I had known I was going to be admitted privately, I would have looked for a cleaner, newer private room in the new part of the hospital! Can't fault the care and attention, they were super, and I was very ill for a time....

 

[Bronco Lane]

That had nothing to do with having private health insurance though.

But they probably charged based on him being a private patient.

No. but as a private patient we were told that there were no private rooms available so they put him in a public ward. When he tested for MRSA they suddenly had a private room.