VHI VHI need specific code for procedure?

H

handtight

Registered User
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Evening all

I asked VHI to confirm if I'm covered for a CT scan and they said I needed to get back to my clinic for the specific code for the procedure. Is this normal practise? I would have thought that for a common procedure the insurer should be able to confirm based on my contribution status?

I'm new to all this and concerned about being pushed from billy to jack on red tape issues.

Any insights on this carry on much appreciated.
 
Whoever has prescribed the scan should be able to give you the exact code.

There is no billy to jack going on here. This is standard practice.

Brendan
 
Hi Brendan,

thanks for prompt reply as I said I'm new to all this and still maybe a bit traumatised at what could be in prospect. I discussed VHI as an option with the referring clinic and I would have thought they would quote the code upfront if it's a routine requirement in terms of confirmig cover?

Accept it's a relatively small point and don't want to appear unreasonable....
 
Definitely standard practice that VHI would request the code as have been down this road in the past. The consultant's secretary may be able to give you the code if you are going private or phone the relevant department in the clinic itself and they should be able to help.
 
I would be interested to see how you get on with this handtight as I had an issue with this myself a year ago and it was not very satisfactory at all. My one year old had to have an operation at a children's hospital in Dublin and I was most anxious to make sure it was covered under my health insurance policy, I think it was Laya. I rang them and they said I would need a code, so I rang the consultants secretary who seemed to think it was very unorthodox and said I didn't need it. Rang insurer back who assured me it was common practice to give codes to ensure that procedure was covered, rang back secretary who told me to ring administration, who told me to ring someone else, who told me they don't give out the codes until the procedure is done. Rang back Laya, who said they most definitely needed the code and that it was most unorthodox that I wasn't being given it, to confirm if he was covered for the procedure or not. Eventually, Laya said, that based on my level of cover, they could only assume that it would be covered but that I could not take it as a given until they had the code. My son needed the op, so I just had to hope that it would be covered (it was). It was incredibly frustrating. Incidentally, it was a fairly routine operation and one that is quite common so its not like it was out of the ordinary.
 
Every condition, disease, diagnosis, scan, procedure etc. has a code. Secretaries deal with this on a daily basis. It's strange that there's any difficulty getting access.
 
funnymunny said:
I rang the consultants secretary who seemed to think it was very unorthodox and said I didn't need it. Rang insurer back who assured me it was common practice to give codes to ensure that procedure was covered, rang back secretary who told me to ring administration, who told me to ring someone else, who told me they don't give out the codes until the procedure is done.
Click to expand...

This just makes no sense at all.

Insurance policies have different levels of cover for different hospitals. The only way to know if you are covered is to have the exact code. It's shocking that you had to have the operation without knowing whether you were covered or not.
 
This is definitely the case - a code is required from having mole removed to hip replacement - these codes are usually 3 or 4 digits - all insurers, hospitals, consultants have access to these codes. The consultant secretary would also have copy of procedure codes - once you have the code and advise your insurer they can confirm yes/no is covered and what procedure is -
 
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