Large Health Insurance claim for premature baby

rodge123

Our baby girl decided to arrive about 8 weeks early, she's out and doing great now luckily.

We received an invoice from The Coombe for €45,000! (56 days)
They attached a form for us to sign so they will deal directly with our Insurance company - Laya.
It's a waiver stating the we waive our entitlement to be treated as a public patient. (On behalf of our baby girl I suppose who we added to our plan when born).
They are basically asking us to retrospectively state we want her to be treated as a private patient.
I don't think our girl received any extra services for her care in neo-natal wards than any other babies.

My wife signed a waiver when admitted into labour ward stating she wanted to be treated as private patient - we received that bill and Laya sorted it all.

I checked our Laya Insurance cover - it's Simply Connect and has full cover for private room in public hospitals.

Should I just sign it and send off?
If I refuse to sign, will I be personally charged the invoice?
Or would I be invoiced a fee for public use of hospital? (€75 per day, would Laya cover this)

It bothers me that she may have received no extra services and they want to charge a huge sum for nothing....no wonder premiums are jumping every year!

MarkR

Right now it's between the hospital and your health insurance. I'd keep it that way. If laya have any concerns about the rate, I'm sure they'll contact you.

Most importantly... Congrats on the new arrival. :-)

Browney7

Talk to laya before signing - if everyone signed these forms and they shouldn't have, health premiums could sky rocket. It may be legit but seems crazy

homer911

Dont sign the form, the hospital will invoice you the standard public rate and Laya will pay this. I find this rule outrageous - you pay for health care through taxes and PRSI and are then expected to pay again, for exactly the same level of service, through your insurance

noel100

Laya sent out a letter 2 weeks ago about this if you were treated as a public patient then you shouldn't sign these forms they will honour the fees charged by the hospital but if you make public treatment as a private treatment it will push all future premiums up.

coylemj

The 'Future of Healthcare' committee in the Oireachtas is currently mulling over a proposal that the public and private systems in the health service be completely separated and that no private patients would be treated in public hospitals. What they don't seem to realise is that the public hospitals rake in millions every year by the stunt the OP is describing and if the proposals were implemented, there would be no change at all in demand but the hospitals would lose this revenue overnight.

I had my appendix out in St. Vincent's public hospital a few years ago, I went in via A&E with a letter from my GP so I wasn't even liable for the €75 charge. The day after the operation, a lady with a clipboard appeared by my bed, asked me if I had medical insurance, I told her I was with the VHI so a few weeks after I got home the VHI wrote to me and said they had paid hospital and consultant about €8,000. If that happened today I would have said I had no insurance. I agree with poster homer911 above, why should I pay twice (tax and medical insurance) for the same service?

wordofwarning

coylemj wrote: »

If that happened today I would have said I had no insurance. I agree with poster homer911 above, why should I pay twice (tax and medical insurance) for the same service?

Hospitals are stuck for money. Various insurers are making massive profits. The taxpayer is subsidising health care and then insurers are collecting a premium to only a pay fraction of the cost of providing that health care.

OPs health insurer is likely going to only pay a fraction of that cost if OP says they were a public patients with no health insurance. We have a situation where the taxpayer is paying for most of the operation and the insurer pays a tiny amount of it. Hospitals want insurers to pay a fairer share of the cost of healthcare.

judeboy101

wordofwarning wrote: »

Hospitals are stuck for money. Various insurers are making massive profits. The taxpayer is subsidising health care and then insurers are collecting a premium to only a pay fraction of the cost of providing that health care.

OPs health insurer is likely going to only pay a fraction of that cost if OP says they were a public patients with no health insurance. We have a situation where the taxpayer is paying for most of the operation and the insurer pays a tiny amount of it. Hospitals want insurers to pay a fairer share of the cost of healthcare.

How do private and hi tech hospitals survive if they get no tax payer money, esp ones not co located with public hospital?

august12

rodge123 wrote:

It bothers me that she may have received no extra services and they want to charge a huge sum for nothing....no wonder premiums are jumping every year!

rodge123 wrote:

Should I just sign it and send off? If I refuse to sign, will I be personally charged the invoice? Or would I be invoiced a fee for public use of hospital? (€75 per day, would Laya cover this)

I wouldn't sign it, send it back explaining you wish her to be treated as public and your health insurance will cover the 75 euro a day fee subject to max of 750 i think. This happened to me as well in a local hospital, i had a procedure done, went in as public and hospital sent a form to me to sign as a private patient even though it was confirmed when admitted i was public. I refused to sign and sent back form to them explaining my reason why. Health insurance covered the public charge of 75 euro. This is the very reason why our premiums are sky rocketing over the last number of years, you are right to query this.

Browney7

wordofwarning wrote: »

Hospitals are stuck for money. Various insurers are making massive profits. The taxpayer is subsidising health care and then insurers are collecting a premium to only a pay fraction of the cost of providing that health care.

OPs health insurer is likely going to only pay a fraction of that cost if OP says they were a public patients with no health insurance. We have a situation where the taxpayer is paying for most of the operation and the insurer pays a tiny amount of it. Hospitals want insurers to pay a fairer share of the cost of healthcare.

Health insurers will keep making the "massive" profits regardless as all increases will be passed onto the customer in some shape or form. If "private" patients get no different treatment in a public hospital why should their insurer have to pay?

notharrypotter

rodge123 wrote: »

My wife signed a waiver when admitted into labour ward stating she wanted to be treated as private patient

Wonder if this may be relevant?

ED E

The fast one has already been pulled here, the admins go at times specifically when patients are stressed so they dont properly review what they're agreeing to.

rodge123

notharrypotter wrote: »

Wonder if this may be relevant?

Not 100% sure but I think that was related to her treatment, I'll call hospital accounts department next week and ask them to explain what extra services were provided above what would have been received as a public patient.
I'll also call Laya to see what they say.
Maybe they could give me 20k and I wont sign it:D

coylemj

judeboy101 wrote: »

How do private and hi tech hospitals survive if they get no tax payer money, esp ones not co located with public hospital?

They already do survive - Blackrock Clinic, Hermitage, Beacon - they don't get any public money, except where they have spare capacity and they bid to take a public patient off a waiting list for cash from the HSE's National Treatment Purchase Fund but the vast bulk of their revenue comes from private patients and none of that treatment involves public money.

coylemj

rodge123 wrote: »

Not 100% sure but I think that was related to her treatment, I'll call hospital accounts department next week and ask them to explain what extra services were provided above what would have been received as a public patient.

They will have no answer to that question unless they gave her a private room on the basis that she was a private patient i.e. which she would not have been given as a public patient.

And it goes without saying (but I'll say it anyway) that her medical treatment was the same regardless.

judeboy101

coylemj wrote: »

They already do survive - Blackrock Clinic, Hermitage, Beacon - they don't get any public money, except where they have spare capacity and they bid to take a public patient off a waiting list for cash from the HSE's National Treatment Purchase Fund but the vast bulk of their revenue comes from private patients and none of that treatment involves public money.

I wonder if the % of my tax/usc/prsi/insurance levy that goes towards public health is greater that the %tax relief I get for having private insurance?

Wesser

They are not charging you a huge sum for nothing. They are charging you a huge sum to save your babies life.

56 days in hospital costs a lot of money as you can see.

If you don't sign it then it will still be free at the point of use.

You are not paying any additional money for extra services. You will not pay any additional money point.

The money that the hse will claim off laya will be used to provide services at the hospital. For example they might be able to employ an extra nurse or maybe a counsellor for pregnancy loss. Or it might just to used to help them keep their head above water.

Del2005

notharrypotter wrote: »

Wonder if this may be relevant?

It looks like they are trying to get a premature baby to take out private health insurance! The OP said that the bill for the Mother has already been settled. So now they want to charge the OPs insurance company for something which can't be done privately and is already covered by the OPs tax and USC.

the14thwarrior

at the risk of getting ridiculed, what is the problem here? she was admitted as a private patient, so she gets billed as a private patient. the cost is irrivelant as such as it is the cost for her stay.

why shouldn't they pay? thats why she has insurance. thats the system

athtrasna

There are no private children's hospitals or private maternity hospitals. Therefore your daughter was treated as a public patient, definitely don't sign

AndrewJRenko

First step would be to clarify whether or not the baby has or had insurance. Be 100% sure that the baby is/was on your policy before you go anywhere.

Let's break down the cost. If baby was in NICU. That requires one to one nursing. Roughly 18000 euros (at the lower end). Consultant and doctoring would add about another 20000 euro. If patient was on TPN, That's roughly 400 euro a day, even if only for a month. That would be 11000 euro. Admin and support staff 5000 euros. Medication :5000 euros. There is the 58000 euro already used up before considering the pharmacist, SALT, dietician, outside consultant referrals, radiographers. To be honest, we don't pay enough towards the running of the health service. People are saying it's ridiculous that the costs are that high. These are high because that was the difference between your child getting to live or just letting them die. This isn't aimed at the OP. Moreso at the people who say that the price is ridiculous. Glad your child is ok.
Sincerely, an overworked, stressed out hospital pharmacist.

rodge123

Wesser wrote: »

They are not charging you a huge sum for nothing. They are charging you a huge sum to save your babies life.

56 days in hospital costs a lot of money as you can see.

If you don't sign it then it will still be free at the point of use.

You are not paying any additional money for extra services. You will not pay any additional money point.

The money that the hse will claim off laya will be used to provide services at the hospital. For example they might be able to employ an extra nurse or maybe a counsellor for pregnancy loss. Or it might just to used to help them keep their head above water.

You are missing the point. My baby was treated the exact same as any other baby in the neo-natal ward - shared rooms, same nurses, same consultants, etc..and they done an excellent job for us and all other babies in there.
I didn't expect nor get different treatment than anyone else.

The hospital is supposed to be funded by the state and should not be fraudulently making claims from insurance companies which will have the effect of ever increasing premiums.

To answer other questions, yes I added our girl to our health insurance straight away.
I imagine the hospital are assuming she has insurance since my wife did.

rodge123

the14thwarrior wrote: »

at the risk of getting ridiculed, what is the problem here? she was admitted as a private patient, so she gets billed as a private patient. the cost is irrivelant as such as it is the cost for her stay.

why shouldn't they pay? thats why she has insurance. thats the system

My wife was admitted as a semi-private patient.
Our baby girl I only added to policy after she was born.

She received same excellent care as all other babies in neo-natal.
As far as I could see, there was no such thing as private care in such circumstances therefore she was treated as a public patient.

Del2005

[Deleted User] wrote: »

Let's break down the cost. If baby was in NICU. That requires one to one nursing. Roughly 18000 euros (at the lower end). Consultant and doctoring would add about another 20000 euro. If patient was on TPN, That's roughly 400 euro a day, even if only for a month. That would be 11000 euro. Admin and support staff 5000 euros. Medication :5000 euros. There is the 58000 euro already used up before considering the pharmacist, SALT, dietician, outside consultant referrals, radiographers. To be honest, we don't pay enough towards the running of the health service. People are saying it's ridiculous that the costs are that high. These are high because that was the difference between your child getting to live or just letting them die. This isn't aimed at the OP. Moreso at the people who say that the price is ridiculous. Glad your child is ok.
Sincerely, an overworked, stressed out hospital pharmacist.

If the OP didn't have insurance they would have received the exact same care. If a person without insurance is admitted to hospital they shouldn't receive the same level of care because they can't afford it?

Our emergency care is excellent and provides great service. People pay private health insurance to get non emergency care. If the people with private insurance cancelled, which will happen as the price continously increases, then the public system will be even worse.

Charging someone several thousand Euro extra for the same level of care would cause uproar if a private company tried it and don't say insurance covers it as insurance can't magic up money, it comes from a pool of healthy people. Why is the public system allowed to do this?

titan18

What basically happens here if you sign the waiver form, the hospital will bill Laya 850 a night for the stay as a private patient (even if you received public care), instead of the 80 a night Laya would be billed for a public stay (and this only goes to max of 800 in a year for the patient).

You could sign it, but look forward to higher insurance costs for it as a result. Laya will also cover the cost of the 80 a night for stay as a public patient.

MIKEKC

The government levy is also driving up the cost of private insurance, they also have your prsi so why should your insurance pay when you get no special treatment ?

jennyhayes123

Kids under 6 weeks are free anyway so it won't cost you for first 6 weeks regardless

titan18

jennyhayes123 wrote:

Kids under 6 weeks are free anyway so it won't cost you for first 6 weeks regardless

Their treatment isn't free

Del2005

Del2005 wrote: »

[Deleted User] wrote: »

Let's break down the cost. If baby was in NICU. That requires one to one nursing. Roughly 18000 euros (at the lower end). Consultant and doctoring would add about another 20000 euro. If patient was on TPN, That's roughly 400 euro a day, even if only for a month. That would be 11000 euro. Admin and support staff 5000 euros. Medication :5000 euros. There is the 58000 euro already used up before considering the pharmacist, SALT, dietician, outside consultant referrals, radiographers. To be honest, we don't pay enough towards the running of the health service. People are saying it's ridiculous that the costs are that high. These are high because that was the difference between your child getting to live or just letting them die. This isn't aimed at the OP. Moreso at the people who say that the price is ridiculous. Glad your child is ok.
Sincerely, an overworked, stressed out hospital pharmacist.

If the OP didn't have insurance they would have received the exact same care. If a person without insurance is admitted to hospital they shouldn't receive the same level of care because they can't afford it?

Our emergency care is excellent and provides great service. People pay private health insurance to get non emergency care. If the people with private insurance cancelled, which will happen as the price continously increases, then the public system will be even worse.

Charging someone several thousand Euro extra for the same level of care would cause uproar if a private company tried it and don't say insurance covers it as insurance can't magic up money, it comes from a pool of healthy people. Why is the public system allowed to do this?

Nicu isn't emergency care.

Wesser

Just sign the form .

Don't you want to give something back to the hospital that saved your babies life.

Seriously . Didn't you feel grateful to the hospital?

Wouldnt you like to give the hospital 58k to say thanks for saving my babies life?