Upgrade my basic plan to include Blackrock clinc and Matter private for orthopedics

bo0li5eumx12kp

On Laya Essential health 300, as is - but with an upgrade to include Blackrock and matter private - exclusively for orthopedic procedures.

Premium wise, what I'm looking at?

Where do I go about finding how to do this?

Wesser

try calling laya?

bo0li5eumx12kp

When I use the HIA comparison tool, the only listed plans for this criteria come from Laya.

What - do other insurance companies not like to offer full orthopedic cover in the high tech hospitals generally?

Brian201888

They do, they'll generally have a co-payment though so Laya are the only ones with "Full" orthopaedic cover but if you take an Irish Life policy for example they'll generally have a €2,000 co-payment for orthopaedic in the high tech hospitals.

The trickier bit is that those co-payments are easily waived to the extent that they're just removed without even asking at times.

"Waivers/Shortfalls

The Mater Private Hospital in Dublin has waived or reduced the shortfall on over 50 procedures, against a wide range of insurance plans, resulting in 100% cover for many patients.

Areas benefiting from this include a range of cancer related procedures, cardiac, paediatric, joint replacement and disc procedures."

That's from the Mater Privates website for example so I'd pretty much disregard the co-pays and treat them as full cover.

bo0li5eumx12kp

Brian201888 wrote: »

They do, they'll generally have a co-payment though so Laya are the only ones with "Full" orthopaedic cover but if you take an Irish Life policy for example they'll generally have a €2,000 co-payment for orthopaedic in the high tech hospitals.

The trickier bit is that those co-payments are easily waived to the extent that they're just removed without even asking at times.

"Waivers/Shortfalls

The Mater Private Hospital in Dublin has waived or reduced the shortfall on over 50 procedures, against a wide range of insurance plans, resulting in 100% cover for many patients.

Areas benefiting from this include a range of cancer related procedures, cardiac, paediatric, joint replacement and disc procedures."

That's from the Mater Privates website for example so I'd pretty much disregard the co-pays and treat them as full cover.

Are there any other websites to compare these plans apart from HIA?

Cause that's only pulling up Laya plans.

Marcusm

Why Blackrock and Mater Private particularly? Santry Sports Clinic, Beacon and Hermitage have some specialists which perform orthopaedic procedures not used elsewhere. I would suggest that access to the right practitioner and right technique is more important than the location. Some practice at more than one.

bo0li5eumx12kp

I'm curious also as to why many plans cover the Beacon but not Black Rock or Matter Private?

As far as I can tell, the Beacon is just as modern if not more so...?

bo0li5eumx12kp

Marcusm wrote: »

Why Blackrock and Mater Private particularly? Santry Sports Clinic, Beacon and Hermitage have some specialists which perform orthopaedic procedures not used elsewhere. I would suggest that access to the right practitioner and right technique is more important than the location. Some practice at more than one.

Procedure I require continuous care for, the top specialist practices primarily from the former two.
Does practice in the Beacon also, but get dates only sporadically so, long waiting list typically.

banie01

Gabriela Magnificent Chimpanzee wrote: »

Procedure I require continuous care for, the top specialist practices primarily from the former two.
Does practice in the Beacon also, but get dates only sporadically so, long waiting list typically.

If your condition is preexisting you will have to serve the wait periods before any cover for that condition is covered by your upgraded policy AFAIK.

You may be covered at present by your insurance for the lower tier hospitals.
However when you bump your cover up, the waiting period for the higher tier starts.

bo0li5eumx12kp

Brian201888 wrote: »

They do, they'll generally have a co-payment though so Laya are the only ones with "Full" orthopaedic cover but if you take an Irish Life policy for example they'll generally have a €2,000 co-payment for orthopaedic in the high tech hospitals.

The trickier bit is that those co-payments are easily waived to the extent that they're just removed without even asking at times.

"Waivers/Shortfalls

The Mater Private Hospital in Dublin has waived or reduced the shortfall on over 50 procedures, against a wide range of insurance plans, resulting in 100% cover for many patients.

Areas benefiting from this include a range of cancer related procedures, cardiac, paediatric, joint replacement and disc procedures."

That's from the Mater Privates website for example so I'd pretty much disregard the co-pays and treat them as full cover.

Disregard co-payments?

I mean, they're stated pretty emphatically on all those plans.

That seems like quite a leap of faith to just, "disregard" them.

bo0li5eumx12kp

banie01 wrote: »

If your condition is preexisting you will have to serve the wait periods before any cover for that condition is covered by your upgraded policy AFAIK.

You may be covered at present by your insurance for the lower tier hospitals.
However when you bump your cover up, the waiting period for the higher tier starts.

Pfff - insurance in Ireland is a joke.

How long are the waiting periods?

I know if I just took out insurance, period - it'd be five years.
That hardly applies to a higher policy, does it?

Brian201888

As I said that quote is from the Mater Privates website and Blackrock states similar. I work in the field, the hospitals will remove a co-pay

Brian201888

Easiest thing to do is call the hospitals and say you're on Be Fit 2 for example with Irish Life Health with it's 2k co-pay and ask if they would treat you without it as you can't afford

Brian201888

Gabriela Magnificent Chimpanzee wrote: »

Pfff - insurance in Ireland is a joke.

How long are the waiting periods?

I know if I just took out insurance, period - it'd be five years.
That hardly applies to a higher policy, does it?

2 year upgrade rule applies to any pre-existing conditions

banie01

Gabriela Magnificent Chimpanzee wrote: »

Pfff - insurance in Ireland is a joke.

How long are the waiting periods?

I know if I just took out insurance, period - it'd be five years.
That hardly applies to a higher policy, does it?

I'm not 100% certain but I do think that it is the same as a pre-existing condition so 5yrs.

Brian has more experience so I'll defer to him

Brian201888 wrote: »

2 year upgrade rule applies to any pre-existing conditions

Speak to your insurance company and get their input.
Expecting the cover to apply immediately for a pre-existing condition is more than a little hopeful IMO.

bo0li5eumx12kp

Brian201888 wrote: »

2 year upgrade rule applies to any pre-existing conditions

Well, seems are you're clued on on the topic;

Would you have any plan recommendation as to upgrading from Laya essential health 300 - for the aforementioned requisites?

i.e. "full" orthopedic cover in BC and MP?

bo0li5eumx12kp

Other thing is - my policy was renewed in April.

When one wants to change policies - do they have to wait until their renewal date?

Cause I want to get this moving ASAP.

Is there like, a change over fee?

And in terms of finding the correct policy - do insurance companies intentionally make it difficult by drowning you in innumerable options and basically making you sort through their various plans/points of cover/no-cover, whilst incorporating other innumerable loopholes that seem to make each condition highly ambiguous.
"Am I really covered here"??

VHI/Laya/Irish life - I mean, I know exactly what I want/need.

What I have now pretty much, more or less - plus orthopedic cover for the high-tech spots - with or without this co-payment which is now supposedly universally waived?

Finding the plan should be easy.

It's not.

Not at all.

Eggs For Dinner

Gabriela Magnificent Chimpanzee wrote: »

Pfff - insurance in Ireland is a joke.

How long are the waiting periods?

I know if I just took out insurance, period - it'd be five years.
That hardly applies to a higher policy, does it?

Why is it a joke? You're effectively looking for additional cover so you can put in a claim immediately. That's not how insurance works.

bo0li5eumx12kp

Eggs For Dinner wrote: »

Why is it a joke? You're effectively looking for additional cover so you can put in a claim immediately. That's not how insurance works.

It is in some countries.

The countries that view insurance not as a business, but as a system to maintain universal well being.

Eggs For Dinner

Gabriela Magnificent Chimpanzee wrote: »

It is in some countries.

The countries that view insurance not as a business, but as a system to maintain universal well being.

I don't think so

bo0li5eumx12kp

Okay I checked into this a little.

Reasonable premiums are available from BC and MP BUT - the issue is, overnights are only covered to about 30%.

So, if, by example - torn ACL, I'm sure that requires a few nights in.

That's a pretty hefty co-payment to make.

Day procedures are covered but, I don't think you can just chill at a regular hospital, then get transported to the BC and/or MP for a day case, then get sent back to a regular hospital.

Co-payments of up to 70% are gonna be waived by those hospitals??

Brian201888

Have a look at Company Plan Plus Level 1.3 with VHI, ortho procedures will generally fall under Specialised procedure cover in the high tech hospitals, get the procedure code from the hospital and confirm that's the section it's covered under with VHI

bo0li5eumx12kp

Brian201888 wrote: »

Have a look at Company Plan Plus Level 1.3 with VHI, ortho procedures will generally fall under Specialised procedure cover in the high tech hospitals, get the procedure code from the hospital and confirm that's the section it's covered under with VHI

I should have been clear about my understanding of ortho procedures also - cause that may be lacking clarity.

I mean - sports injuries.
Not hip or knee replacements like old folks get.

Broken bones requiring plates and screws, ligament tears, knee reconstruction etc.

If they're classified as ortho procedures but, I don't really know.

VHI said that overnight cover is only provided for the BC and MP on their highest possible form of cover - that being platinum something something, which comes in at about 6 times my current premium.

So - I don't get that - waiving the co-payment etc, whether they're gonna do that when the co-payment is 70%?