Health Insurance query

nice_guy80

Simple story, I have no health insurance

I hurt my knee playing sport a few months ago - have not gone to a doctor or sought any medical advice on it

basically, I fear it will need surgery to correct the problem as its probably an external ligament damaged

So I want to know what Health Insurance policy would be best for me to get, as I know surgery is costly.

The policy should cover
surgery
hospital costs
scans
cunsultant visits? (preferrably)
GP visits?

any advice?

broker2008

If you are taking out health insurance for the first time and have a pre-existing condition, the health insurer can impose a waiting period in respect of cover for treatment for this condition. The maximum waiting periods that the health insurer may impose in this case are as follows:

• 5 years, for a person who is under the age of 55 years.
• 7 years, for a person who is of or over the age of 55 years and under the age of 60 years.
• 10 years for a person who is 60 years or over.

These waiting periods may apply from the date of policy commencement. It should be noted that whether or not a condition existed at the time that an insured person began serving a waiting period is decided on the basis of medical advice. Whether or not the insured person was aware that they had the condition at the time that they started serving the waiting period may be considered not to be relevant by the insurer. If this matter is important to you, you should consider clarifying it with your insurer.


You could get the scans covered without any waiting period as they will be an out patient expense as well as a plan that covers an amount for consultant and GP visits which can also be bought without hospital cover called cash plans. Have a look at hia.ie for further info.

dollydishmop

nice_guy80 wrote: »

So I want to know what Health Insurance policy would be best for me to get, as I know surgery is costly.

Its FREE if you stay in the public system.

nice_guy80 wrote: »

The policy should cover
surgery
scans
cunsultant visits? (preferrably)

Also all FREE on the public system.

nice_guy80

dollydishmop wrote: »

Its FREE if you stay in the public system.



Also all FREE on the public system.

I don't want to wait years to get surgery done

I don't have a medical card

hospitals, GPs and consultants charge money!!!

Dan133269

broker2008 wrote: »

Whether or not the insured person was aware that they had the condition at the time that they started serving the waiting period may be considered not to be relevant by the insurer..

It is considered relevant by a court. A consumer cannot be held to have acted in bad faith if he/she was not aware of a pre-existing medical condition nor ought to have been aware of it. Am I right in saying this?

dollydishmop wrote: »

Its FREE if you stay in the public system.



Also all FREE on the public system.

You've never had to use the public health system, have you?

NuMarvel

nice_guy80 wrote: »

I don't want to wait years to get surgery done

I don't have a medical card

hospitals, GPs and consultants charge money!!!

As broker2008 pointed out above, pre-existing conditions are subject to waiting periods of at least five years, so taking out health insurance now won't cover you for a stay in hospital for the the injured knee.

Once you've seen a doctor about the injury, you'll be in a better position to know what your options are. Once the doctor has examined the injury, they will probably refer you for an x-ray or something other kind of scan of the knee, depending on the severity of the injury, or they'll refer you to a consultant specialist (I'm not a doctor, there are probably other options, but these are the ones that would incur the most cost if you went privately).

Waiting times for out-patient tests and consultant vists are where the bottlenecks in the public system are, but let the GP refer you first as it may not be as bad as you think depending on who or where the doctor refers you to. When/if you go to see a consultant and if they say you need to be admitted to hospital, then the National Treatment Purchase Fund (www.ntpf.ie) will look at your case if you're waiting more than three months to be admitted and try to arrange treatment quicker in a private hospital (at no charge to you).

You do have the options of going privately and paying for the costs yourself, but that would prove costly. A consultant vist is anything from €130 to €200, a stay in hospital would be at least a couple of hundred per night, plus other costs like the scan, other hospitals charges, etc. It's hard to put a figure on it as it depends on the treatment you would be getting, what hospital you would be in and what your consultant decides to charge. On the plus side, if you're a PAYE worker you at least get 20% tax relief on it.

NuMarvel

Dan133269 wrote: »

It is considered relevant by a court. A consumer cannot be held to have acted in bad faith if he/she was not aware of a pre-existing medical condition nor ought to have been aware of it. Am I right in saying this?

The Financial Ombudsman has examined complaints on this kind of matter before, and from what I can see, he found in favour of the health insurer in most cases, usually because he feels the definiton of pre-existing as stated in the policy documentation was clear. The one exception I found is because the insurer didn't have enough medical evidence to back up their claim that something was pre-existing. Just for clarity though, none of the cases I saw specifically stated that a person wasn't aware of a pre-existing condition.

However, the Ombudsman is not the court, so an appeal to the High Court might result in an alternative judgement.

oldyouth

nice_guy80 wrote: »

I don't want to wait years to get surgery done

I don't have a medical card

hospitals, GPs and consultants charge money!!!

That's why people take out health insurance. Jaysus, if it was as easy as taking out a policy after you need it, I'd be taking up that option

dollydishmop

nice_guy80 wrote: »

I don't want to wait years to get surgery done

I don't have a medical card

hospitals, GPs and consultants charge money!!!

I don't have a medical card either.

I pay my GP when I go to see them, and the times I've needed to be in hopsital overnight I've paid the standard €75 overnight fee. More often than not I've had a private or semi-private room allocated to me.

I have a DPS card and I pay €120/month on prescriptions.

I'm currently under 5 different consultants, and I don't pay a penny to see them.

The last operation I had went something like this:
Decision to have the op was made at the end of March, during a consulation with one of my consultants, involving a conference call with 2 more of my constulants.
I had a pre-op appointment with the surgeon during April.
The op was done in May.
In the 8 weeks between the time the decision was made, and the op itself, I was in the hosp for various appointments with the different consultants several times, at some points up to 3 times a week in different departments, to ensure that my blood levels and other indicators were as good as they could possibly be going into the op.
A huge medical team went above and beyond to make sure I was well enough for the op, that the op went well and that my recovery from the op was as seamless as possible...and I really cannot fault anyone at all.
Immediately after my op I was in Intensive Care, and then subsequently moved to a private room.

All done publicly...and all done for free.

I should also add that in the past few years I've also had several CAT scans, and 2 MRI scans...also all done free.

Would insurance have made a difference in the level of care I received?...oh yeah, it would have cost me an absolute fupping fortune, and that's about it!!!

Dan133269 wrote: »

You've never had to use the public health system, have you?

haha...on the contrary, with all my (numerous) health conditions I actually make FULL use of the public health system, on a more regular basis than most...and I honestly believe that insurance would make absolutely no difference to the level of care I have received,and will continue to receive. My illness is with me for the rest of my life - I'm a fully paid-up member of the Missing Organ Club

Personally I think that there's a little bit of hysteria built up over health insurance...I swear some folks believe they'll be left dying in a gutter if they didn't have insurance...