Health insurance and public hospitals.

UrbanFox

Apologies in advance if this has already been done but the question arises for us now as we are reviewing health insurance option for the new year.

If I go to a public hospital either through A & E or to outpatients on referral by my G.P. the hospital will ask if I have health insurance.

Q1. Am I obliged to disclose whether or not I hold health insurance ?

Q2. If so, why ?

Q3. If I do hold health insurance and tell the public hospital are there any risks that I might end up paying charges out of my own pocket ?

In relation to Q3 what occurs to me is this. If I attend a public hospital as a public patient I will not have to pay charges for the service - except the A & E charge (if I have no referral letter from my G.P.) and the bed charge if I have to stay over.

However, is there any danger that if the hospital attendance produces a claim against a health insurance policy that there might be a shortfall if a policy does not cover 100% of the hospital charges.

Worded less awkwardly, could I find myself paying a shortfall because I have a health insurance policy where I would otherwise pay nothing if I was an uninsured public patient ?

coylemj

UrbanFox wrote: »

Worded less awkwardly, could I find myself paying a shortfall because I have a health insurance policy where I would otherwise pay nothing if I was an uninsured public patient ?

Not in a public hospital you won't but if you tell them that you have medical insurance, they will ask you for the details and bill your insurance company on the basis that you were treated as a private patient. Any consultant that treats you will also submit a bill but there will be no excess and you won't be asked for a 'top-up'.

That's what happened me when I was treated (via A&E) in a public hospital a few years ago. A lady from admin. (she had a clipboard and was wearing office clothes) came to my bed on the second-last day and casually asked me if I was in the VHI. Several weeks later the VHI wrote to me telling me that I had been treated as a private patient in a semi-private ward (there was three beds, it was a public ward and the food was sh1te) and they paid the consultant as well even though technically he was on his public time (for which he was paid by the HSE) and shouldn't have claimed a cent.

So to answer your first question.... you are not obliged to tell the public hospital that you have insurance and if I was in the system again, I would tell them that I had no insurance. As far as I'm concerned, my taxes and PRSI pay for the public health system. Why should my medical insurance premium prop up the public system and why should I pay twice for the same service?

It's only when you go to some private hospitals or meet a consultant privately that your medical insurance may not cover the full cost and you may find that you have to supplement the cover with your own money.

UrbanFox

coylemj wrote: »

Not in a public hospital you won't but if you tell them that you have medical insurance, they will ask you for the details and bill your insurance company on the basis that you were treated as a private patient. Any consultant that treats you will also submit a bill but there will be no excess and you won't be asked for a 'top-up'.

That's what happened me when I was treated (via A&E) in a public hospital a few years ago. A lady from admin. (she had a clipboard and was wearing office clothes) came to my bed on the second-last day and casually asked me if I was in the VHI. Several weeks later the VHI wrote to me telling me that I had been treated as a private patient in a semi-private ward (there was three beds, it was a public ward and the food was sh1te) and they paid the consultant as well even though technically he was on his public time (for which he was paid by the HSE) and shouldn't have claimed a cent.

So to answer your first question.... you are not obliged to tell the public hospital that you have insurance and if I was in the system again, I would tell them that I had no insurance. As far as I'm concerned, my taxes and PRSI pay for the public health system. Why should my medical insurance premium prop up the public system and why should I pay twice for the same service?

It's only when you go to some private hospitals or meet a consultant privately that your medical insurance may not cover the full cost and you may find that you have to supplement the cover with your own money.

That was an interesting experience. Thanks for that. I must say that I would be inclined to think on similar lines if I was in your situation.

Nonoperational

I'd tell them. Some scans will be done quicker if private. Ridiculously stupid paying for insurance then sitting in hospital waiting 3 days for an MRI when you could have it done and be home 2 days earlier.

curiosity

Every policy is different (track down your benefit details), but I'd imagine that most policies cover public hospital stuff. I was admitted to hospital via A&E earlier this year, no-one asked me if I had health insurance. They sent me a bill a few weeks after for the in-patient charge, advising me to pass on my health insurance details, if I had any. No cost to me. If you're paying for health insurance, make use of it if needed.

Arbiter of Good Taste

coylemj wrote: »

Not in a public hospital you won't but if you tell them that you have medical insurance, they will ask you for the details and bill your insurance company on the basis that you were treated as a private patient. Any consultant that treats you will also submit a bill but there will be no excess and you won't be asked for a 'top-up'.

That's what happened me when I was treated (via A&E) in a public hospital a few years ago. A lady from admin. (she had a clipboard and was wearing office clothes) came to my bed on the second-last day and casually asked me if I was in the VHI. Several weeks later the VHI wrote to me telling me that I had been treated as a private patient in a semi-private ward (there was three beds, it was a public ward and the food was sh1te) and they paid the consultant as well even though technically he was on his public time (for which he was paid by the HSE) and shouldn't have claimed a cent.

So to answer your first question.... you are not obliged to tell the public hospital that you have insurance and if I was in the system again, I would tell them that I had no insurance. As far as I'm concerned, my taxes and PRSI pay for the public health system. Why should my medical insurance premium prop up the public system and why should I pay twice for the same service?

It's only when you go to some private hospitals or meet a consultant privately that your medical insurance may not cover the full cost and you may find that you have to supplement the cover with your own money.

I've never seen a public ward with only three beds. Hell, I was in a semi private ward in the Mater Private and there were 6 beds!

witchgirl26

The only time, in general, that you'd be asked for an excess is if you're attending private hospitals. Most of the policies cover hospital stays in the public hospitals so it shouldn't cost you anything.

Like Nonoperational said above - one benefit of saying that you have insurance is potential quicker access to scans. I know for my dad when he was in the Mater, they were able to bring him from the public down to the private for a scan quicker than if he waited in the public.