Hi,
Very sorry to hear about the accident.
The Dublin dental hospital not being recognized is an anomaly for sure. I believe it is done this way so as to show that in patient procedures in that hospital are not covered, eg surgery etc. However as a result it seems to extend to any outpatient dental benefit too, so for small procedures or consultations it may be better to go to a private dental practice, where you can claim this benefit back.
VHI plans have a section in the table of benefits which is referred to specifically as fixed price procedures (FPP's). It seems a lot of plans only cover a % of this, around 50-90%.
FPP's are separate to all other procedures and this categorisation is specific to VHI. I am not sure if this is what you are referring to specifically in your title. If this is what you are talking about then FPP's are in general the more complex and expensive procedures, usually only done in what's sometimes categorised as high tech hospitals. If you are a VHI customer you can request this list and they will mail a hardcopy out to you with exactly every procedure on it.
Otherwise all other procedures are covered as per your table of benefits to your plan. Again hospital categorisation is a little different with the different insurers. Eg. With VHI you'll see private hospitals categorised as private 1,2,3, or 4. These procedure codes are negotiated between the hospitals and the insurance company. It should be taken that if the hospital has medical procedures it knows it has to carry out, it will have organsied it with the insurance companies and it will be coded. The insurers state they don't want all of these procedure codes public as they deem it private property. Apparently it costs a lot of money and takes a lot of effort to make, negotiate and update these lists of procedures and if it were public, other insurance companies will just copy their work. I think there was some complaint/ law suit over this issue some years ago.
In terms of worrying about being referred and what you are covered for here is how I tackle it.
If you go to your GP and you need a referral to a specialist, the GP may be inclined to refer you to someone specific straight away or they may ask you. You are well within your rights to specifically ask your GP to send a referral to a particular doctor or hospital. If it catches you off guard and you're not sure you can also always ask your GP to give you a general or open referral. Then you can take this letter to any hospital or consultant directly once you have chosen. This way you can buy yourself time to research consultants/hospitals or contact your insurer to query cover.
As a rule of thumb it may be best to look at which of your nearest hospitals your plan covers that you would want to go to. Make a list and keep this in mind for your whole year of cover. With VHI you can look this up online with the facility finder. Look at the hospital cover vs the table of benefits for your plan. Eg. You may have full cover for both day case and inpatient cases in the Beacon but only day cases in the mater private. If you're put on the spot, you can just ask for a referral to the Beacon, knowing that you have both day and overnight cover (the greatest range of procedures).
Next step is to double check the consultant is approved and working with your insurance company before you attend a consultation. ( If the hospital is covered, very likely the consultant is covered too but this is not always the case so it's always best to look it up. ) With VHI you can check this online.
Once the consultant books you in for the procedure you will get a procedure code, as I am sure you are already familiar with. At that point you contact your insurer and get full confirmation you are covered and confirm how much your excess is, if any.
if you follow a similar sort of steps, it's unlikely you will go to a consultation with a doctor at a hospital that you don't have cover for procedures in.
I know health insurance can be a minefield to navigate so I hope some of this is useful to you and that your wife has a swift recovery. If you have anymore queries I'll do my best to reply.