Health Insurance VHI FPPs lists and procedure codes

[waldino]

Hi there,

I'm sort of despairing at the state of our health insurance in Ireland in terms of how opaque and vague the details of coverage can be. For example I'm an existing VHI customer looking at changing plans. In the plans I've been looking at it says to contact VHI for details of FPP procedures level 1 and level 2, but have been stonewalled so far when I ask for them. Same issue for procedure codes, I was told on the phone they don't give this out. But not giving these 2 items out amounts to not actually knowing in advance what I am or am not covered for under a particular plan. How is this even legal? It even says at the very start of the Terms and Conditions for each plan that they should be read in conjunction with the Schedule of Benefits for Professional Fees, and yet when asked for this Schedule, I'm told we don't give those out. So they are refusing to share a component of a contract that I'm signing up to and told by them to read! I can't think of another situation where this would even be considered legal behaviour to do this? It's like a 3 -card trick!

Furthermore, I've noticed that Irish Life have all of their procedure codes published on their website, so I don't understand why they can do it, but VHI refuse to (under the auspices of it being commercially sensitive- Irish life have published codes and it doesn't tell me anything commercially sensitive about Irish Life and their arrangements!)....

Has anyone been successful in getting the FPP list or procedure codes from VHI?

Is there any actual enforced regulation of this sector? Is it the ombudsman or HIA?

Thanks for any info,
Frustrated health insurance consumer!

 

[Mamamia22]

The insurers cover pretty much identical procedure codes to my knowledge. The details that differ between plans are all on hia.ie the last time I checked. I wouldn’t worry about codes if you are insured and are happy with the general outline of your plan I.e private vs semi private and hi tech hospitals or not, excesses etc then everything is pretty much covered in those hospitals. Codes are for claims only and I wouldn’t bother with them at the time of renewing insurance.

 

[ClubMan]

It's a fair enough complaint though. I too have tried to find this sort of detail, generally and in advance of specific procedures, and it was confusing and unclear. Not just with VHI I should say, even though I'm covered by them at the moment. There really should be more clarity about what exactly is covered by each insurer and policy in my opinion. It's presumably an issue for the HIA to deal with or regulate. But insurers themselves should really aim for maximum transparency regardless.

 

[Sue Ellen]

Reading the OPs post and then reading the advice from the Ombudsman here would make one worry alright about ensuring that you have the right cover when renewing

 

[Sue Ellen]

I only remembered these comprehensive posts from Starrynights in this previous AAM thread this morning (sad or wha' ) and felt that they may give some help/advice for OP on the FPP aspect.