Temple street with private insurance

LirW

Okay, I'm extremely confused and maybe fellow parents have any experience in that.

My son, 6, does need a circumcision for medical reasons. The GP asked if I have a private insurance, which we do, I very basic Laya plan. He referred me to a private consultant in the Mater private. Talking to Laya today, under our plan Mater private is not covered but Temple street is up to a semi-private room.
I was on the phone quite a lot with Laya today and they basically can't tell me anything because they need a consultant name and so on.

Now I'm a bit confused with what that actually means.
When he gets referred to a private consultant - my policy does have a part-coverage for consultant appointments - would I also have to pay parts of the procedure?
Or would it make more sense in general going public and not dealing with Laya in that case?
A circumcision is a day-to-day case as far as I know.

I have to be honest, I have literally no experience with anything like that since we were lucky to never need these services.

Does anyone know how long current waiting lists in public care are?

Also they mentioned anything about pre-existing conditions. Could it be that I end up having to go public anyway because it could be declared as a pre-existing thing?
Again I'm sorry if these questions are stupid.

Rocket19

LirW wrote: »

Okay, I'm extremely confused and maybe fellow parents have any experience in that.

My son, 6, does need a circumcision for medical reasons. The GP asked if I have a private insurance, which we do, I very basic Laya plan. He referred me to a private consultant in the Mater private. Talking to Laya today, under our plan Mater private is not covered but Temple street is up to a semi-private room.
I was on the phone quite a lot with Laya today and they basically can't tell me anything because they need a consultant name and so on.

Now I'm a bit confused with what that actually means.
When he gets referred to a private consultant - my policy does have a part-coverage for consultant appointments - would I also have to pay parts of the procedure?
Or would it make more sense in general going public and not dealing with Laya in that case?
A circumcision is a day-to-day case as far as I know.

I have to be honest, I have literally no experience with anything like that since we were lucky to never need these services.

Does anyone know how long current waiting lists in public care are?

Also they mentioned anything about pre-existing conditions. Could it be that I end up having to go public anyway because it could be declared as a pre-existing thing?
Again I'm sorry if these questions are stupid.

Your cover for a consultant visit (consultation only) is considered outpatient treatment. You will need to pay for the private consultation upfront, and submit the receipt to your health insurer. They may reimburse you (somewhat) for this depending on your level of cover. Depending on your plan, please be aware you may get nothing back, as you have may have to meet an excess on the policy in relation to outpatient treatment.

If your son is admitted to hospital (even as a daycase) for a procedure, this is considered inpatient treatment. This is a separate part of your policy, and is different to the level of cover provided for outpatient treatment such as gp visits or consultant visits). You would usually be covered in full for daycare admissions to public hospitals (provided the hospital is an approved hospital on your plan, and the relevant waiting periods are served). This is inclusive of hospital fees, physician fees, anaesthetist fees, and any scans/tests your son may need while admitted.

Has your son seen the consultant yet? If you have the consultant's name, call his/her office and check what hospitals he/she works out of. You might even be able to check this online, but I would confirm with the secretary to make sure. If he/she works out of Temple Street, you can ask that the procedure be done there. You should query this before seeing the consultant, as you may waste your money if he only works out of the Mater Private, and/or isn't in a position to refer your son elsewhere. Please be aware that there may be longer lists in Temple Street (than the Mater Private), but you will certainly be seen sooner if you go privately (compared to going through public system).

When you meet with the consultant, they will give you a procedure code (this is asssuming the consultant is happy to arrange for the procedure to be carried out), and you can then call laya. They will then be in a better position to advise you once you are certain of the exact procedure being carried out. They can also check that your consultant is registered with them for payment.

The insurer is asking you whether the condition is pre-existing, as your son would only be covered once all the relevant waiting periods have been served. It is up to you to make sure this is the case before he has the procedure done. How long has your son had insurance cover? How long has he had his condition or symptoms of his condition? Has he ever had a break in cover? What is the name of your plan with Laya?

You can certainly choose to go publically, but you may have to wait longer to be seen. You can actually elect to go publically, and the insurer will pay the public charges for you (these are €75 a day up to a max of 10 nights €750) in a year period. You would not be entitled to skip any waiting lists as you would be a public patient. Again, the public charges will be covered by your insurer only if your son has served the relevant waiting periods.

Toots

I had a similar experience with my little boy, he had quite a pronounced phimosis and was constantly getting infections so we were referred to a consultant to see if he needed to be circumcised. We were referred to Crumlin because it's the closest children's hospital to us, and it was the public system. We received a date for an appointment but it was about 8 months away. I contacted my insurance and if I'd gone private I'd have had to pay upfront for the consultation (could have been €500+) and I could have claimed some of it back, however I didn't have €500 upfront.

My little guy kept getting infections in the meantime and in desperation I rang the department in Crumlin and the really lovely lady I spoke to was able to check for cancellations and get him an appointment a bit sooner. In the end the consultant felt that he didn't need a circumcision at that time, but arranged for us to come back in 12 months to check an make sure that he was improving. I think if he'd got to be circumcised it would have been a day case.

mohawk

Its important to understand waiting periods because if you go private and Laya deem your son not to have served waiting periods the claim will be rejected and you may find yourself with more then one invoice to pay.

so make sure you know how long he is covered. Has there been a break in cover over 13 weeks? If he has been covered for 5 years plus there shouldn't be any issues with pre-existing conditions unless you upgraded the policy.

If you have a name of the consultant google will tell you if they work in Temple St. A lot of the consultants work in both hospitals. Make sure surgeons office is made aware you are not covered for Mater Private.

The public waiting list for that procedure is quite long. The HSE regularly has to pay private hospitals to perform the procedure in order to reduce the waiting list.

cbyrd

LirW wrote:

Does anyone know how long current waiting lists in public care are?

About 8 to 10 months, I'm in Mayo, I've had my older son circumcised last August and my younger son was seen last week and given February 20th for his procedure.
I'm going public as I don't have private insurance.
I use Epsom salt and tea tree in the bath to keep infection at bay.
It's a day procedure, my older boy went in at 8am brought to theatre at 10:30 and was released at 4-30 after he had a wee.
Dreading the aftermath again, lots and lots of tlc and painkillers!

LirW

Thanks all of you for your responses!

He served the waiting period for normal treatments, but not the 5 years for pre-existing conditions.
However, I'm gonna ring in the hospital tomorrow anyway because the GP gave me a copy of the referral-letter.

@Rocket 19: We're covered with the Assurance Vitality-plan, so pretty much the most basic one.
The insurance itself said that they'll receive the files from GP and consultant and decide afterwards if this is a pre-existing condition or not.
The thing is, we're with Laya for almost a year now, I started the policy straight after moving to Ireland last year and in Austria he was never seen because of that issue before. So I have no clue of what they are going to assume.
But I'll ring hospital and Laya tomorrow anyway and see where to go from there.
This is all quite confusing, dealing with that for the first time.

I'm in the very lucky position that he doesn't have to deal with permanent infections, so if I'd have to wait a few months it's most likely not going to be too bad for him.

Toots

My little guy was grand all his life up until he was about 4 and then he started having problems. He ended up in A&E with an infection one time because it swelled so badly he couldn't pee. That was when we were referred to the consultant. A good tip the hospital gave us was to give him a bath and put a capful or two of dettol in it, then get him to wee while he's in the bath - that way the end of the foreskin opens up and it cleans in underneath. It worked like a charm for us.

LirW

Thanks Toots, that is actually good to know!

The problem is according to the GP that is foreskin is too long and so tight at the tip that there is no way it'd open up on it's own. I went to see him in the first place because I don't want my lad to have serious problems later on when he might be too ashamed to talk about it. My cousin was forced to tell his parents at the age of 11 when his foreskin literally ripped and got bloody and I remember how uncomfortable that was for him.

Toots

My GP was pretty certain my little guy would need circumcised, but when we saw the specialist he reckoned it could sort itself and I think they generally aren't keen to operate unless they're sure it's needed. The consultant I saw gave us a script for an antibiotic cream (to be used if the infection flared up again) and also a cortisone cream which we were to use every day. We haven't had any problems for nearly a year but it's something we need to always keep an eye on just to make sure it doesn't flare up.

uck51js9zml2yt

Check with the consultant in temple St. Some have an agreement with lays to bill the insurer directly.
My son sees a cardiologist. The fee is 200 which we never have to pay. Also depends on the plan of course.
Just get the procedure code, talk to the secretary and laya.

Tabnabs

Just to add we've been through the same very recently at Tallaght Hospital and have been very surprised at how quick it was. We have decent private health cover, but were referred via the GP through the public system. Saw the consultant a couple of times to see how the issue was progressing and then he decided it was necessary to operate. Nothing about private insurance was mentioned until the very day of the procedure. Private health would mean the consultant himself doing the job and a private room to recover in, also the €80 day patient charge was covered.

For us, it seemed unnecessary to have the consultant do such a straight forward procedure, there were no private rooms available that day (would have been charged for one though!), but covering the €80 charge was the least VHI could do for the huge lump sum we pay.

Everything went well and we have an appointment for a check-up in 4 weeks. Tallaght A&E is famously disastrous, but the National Children's Hospital dept. has been an excellent service for us.

Toots

We've just had another flare up here and I'm very concerned cos the dettol baths and cream aren't working as rapidly as they normally do. The little guy was off school Thursday and Friday last with conjunctivitis last week and now I've had to keep him off again today cos his little penis is in such a state. He was screaming like a scalded cat when he tried to have a wee this morning

LirW

Oh my god, all the best for your little guy!

pc7

Oh the poor little guy awful stuff. Our little one needs a procedure done we have private health insurance. They told us they'll cover surgery in temple street and the cost of a semi private bed, if we get a private room we just pay the difference. We paid €150 for the initial private consultation in the mater.

uck51js9zml2yt

Check your plan. My 2 have seen consultants in temple St which was paid in full by laya( check with the private secretary.)
We also been covered for day cases in the hermitage and in patient treatment in Tallaght.

What you need to do it get the procedure code from the private secretary and check with laya if it's covered and where.
Found laya very good to deal with.

Toots

Castiel Hollow Vehicle wrote: »

Check your plan. My 2 have seen consultants in temple St which was paid in full by laya( check with the private secretary.)
We also been covered for day cases in the hermitage and in patient treatment in Tallaght.

What you need to do it get the procedure code from the private secretary and check with laya if it's covered and where.
Found laya very good to deal with.

I'm going to be ringing around tomorrow to get codes and check prices. I had him in the doc on Tuesday and he was put on antibiotics but had to go back today cos he's still in so much pain. He's avoiding drinking cos he knows it'll make him need to pee. His doc prescribed a lidocaine gel to basically numb his penis so he can go to the loo without pain and has referred us back to Crumlin.

I'm going to check prices and see what my insurance covers - my hubby's work covers us on Care Select with Laya. Don't want to leave this drag on any longer, my parents just booked a family holiday for all of us in July, so the last thing I'd want is the poor little guy being miserable for that.

LirW

With Care Select, which is a much better plan than mine with Laya I'm quite certain they'd cover your poor little lad. I wish you all the best and please keep us updated to what they said!

Toots

Rang the Beacon earlier (it's only down the road from us) and they do the procedure there for kids. The insurance covers the procedure directly, then we've to pay €150 for the pre op consultation and €100 for the follow up appointment but we can claim 75% of those back on the insurance.

I got on to my GP and asked to have the referral letter faxed over to the beacon so hopefully they'll be in touch soon. The secretary said it's usually a week or two wait. I'll let ye know when we hear anything!

cyning

You can claim 20% of anything you can't claim from laya back through your med1 too

Toots

Just wanted to update and let ye know I got a phone call on Tuesday from the Beacon, and they've given me an appointment for next Wednesday morning to meet the consultant.

In the meantime the poor little dude is off school again this week. He finished his last antibiotic on Sunday, and by Monday evening it had flared up again. He was back in the GP on Tuesday, and is on antibiotics again. My GP said to me had I not been going to the consultant the following week, he'd have been sending me in to A&E to see would they admit him for the procedure. It's definitely gotten much worse all of a sudden, but I don't know why.

Granny Pot

Granny Pot wrote: »

Just wanted to update and let ye know I got a phone call on Tuesday from the Beacon, and they've given me an appointment for next Wednesday morning to meet the consultant.

In the meantime the poor little dude is off school again this week. He finished his last antibiotic on Sunday, and by Monday evening it had flared up again. He was back in the GP on Tuesday, and is on antibiotics again. My GP said to me had I not been going to the consultant the following week, he'd have been sending me in to A&E to see would they admit him for the procedure. It's definitely gotten much worse all of a sudden, but I don't know why.

My experience with the Beacon and my son just a couple of years older than yours was great.

GP gave us referral letter, I rang up and got an appointment the following week to see the consultant. We paid the €150 and went in to see the consultant. He checked over my son, confirmed he needed the op, then checked his diary and asked if the following Tuesday morning would be OK for the op.
Following Tuesday, my son had the op. All costs were covered by Aviva. Home that evening and then the real work began! Warm baths every night with some dettol, Calpol and Neurofen regularly. He was off school for 2 weeks and was still a bit uncomfortable for another 2 weeks.
Back to see the consultant 6 weeks after the op and everything was fine by then.

Toots

[Deleted User] wrote: »

My experience with the Beacon and my son just a couple of years older than yours was great.

GP gave us referral letter, I rang up and got an appointment the following week to see the consultant. We paid the €150 and went in to see the consultant. He checked over my son, confirmed he needed the op, then checked his diary and asked if the following Tuesday morning would be OK for the op.
Following Tuesday, my son had the op. All costs were covered by Aviva. Home that evening and then the real work began! Warm baths every night with some dettol, Calpol and Neurofen regularly. He was off school for 2 weeks and was still a bit uncomfortable for another 2 weeks.
Back to see the consultant 6 weeks after the op and everything was fine by then.

Glad to hear your son is recovered now! When he went in for the operation were you allowed to go down to theatre with him or how did that work out?

My little guy would be absolutely hysterical if I wasn't there. I'm hoping I can go down and stay with him til he's asleep and then wait for him to come out. Would they allow that?

pc7

In temple street we were allowed too go down (one of us) so hopefully you can. Best of luck

Toots

Toots wrote: »

Glad to hear your son is recovered now! When he went in for the operation were you allowed to go down to theatre with him or how did that work out?

My little guy would be absolutely hysterical if I wasn't there. I'm hoping I can go down and stay with him til he's asleep and then wait for him to come out. Would they allow that?

Yes, I went down to theatre and was beside him til he went to sleep. Was there as soon as he woke up as well.

Toots

That's great, that's a load off my mind anyway. Did you have to change clothes or how did it work? Also did he have to have an IV? Trying to do some gentle prep with the little dude so he doesn't get any surprises.

Toots

Toots wrote: »

That's great, that's a load off my mind anyway. Did you have to change clothes or how did it work? Also did he have to have an IV? Trying to do some gentle prep with the little dude so he doesn't get any surprises.

They put in the IV in theatre and I did need to put on a gown, hat and shoes covers as I went into the theatre.
They use gas to put them to sleep, so it's good to explain that to your son, that they will put a mask over mouth and nose.

As an aside, it's a huge deal for you and your son but the nurses and doctors are doing this all the time and it's all handled expertly by them.

cbyrd

I'm in tomorrow with my youngest boy, I'm dreading it as my older boy was done last summer.
I did 3 baths a day with Epsom salt and tea tree oil and he didn't wear trousers or underwear for almost 3 weeks.
We had a setback after the first week as he went to his dads (he wasn't as rigorous with the baths) and came home with an infection. So probably took 5 weeks before he was comfortable wearing trousers.

Be prepared for the wound after, I thought it was only the skin at the tip they'd remove but it was almost halfway down and omg it looked so sore. I think my reaction frightened him a bit. I'm usually good at keeping my reactions hidden when it comes to cuts and bruises but this did make me wince.
Best of luck,

Toots

I've been told 1 week for recovery time, ie he'll be able to go back to school a week after. Is that a bit optimistic?

cbyrd

Toots wrote:

I've been told 1 week for recovery time, ie he'll be able to go back to school a week after. Is that a bit optimistic?

That's very optimistic. They're basically peeling back the skin on his penis to roughly halfway, he'll be very sensitive and trousers and underwear will irritate him for a few weeks. There's a high risk of infection too.. I'd give him 2 weeks minimum but I know with my older lad he was over 4 weeks before he was comfortable wearing trousers.
Every child differs but I wouldn't rush him.
We are just post op now and very hungry and cranky ..

Bubbles75

Hi.. my little man will need to have this done too but I haven't spoke to him about the operation yet he's 7.... I' know he'll freak out at the thought of "all the skin being cut away".. how do I put it nicely :)


(hubby says there's nothing nice about it:p:p)