Insurance cover for MRI via private A&E

NeutralHandle

My health insurance covers MRI scans in the Beacon. It doesn't say anything about cover for private A&E visits.

As part of an A&E visit to the Beacon, I might have an MRI. Does anyone know for sure if this would be covered - as a scan - or not covered - as part of an A&E visit?

Obviously I should ask my insurer to get a definitive answer, but it is the weekend so I can't do that today.

coylemj

It's a private hospital so someone is going to ask you for your insurance details, ask that person the question you are asking above.

Sheep Shagger

Call VHI and ask ?

Without anyone knowing what policy you are on nobody here can answer.

wandererz

A&E visits are generally not covered by private insurance.

A family member visited a private hospital A&E for a chest infection and got a bill for €500 a few weeks later.

Sarn

I know that on my policy a referral by a doctor for an MRI is not covered (the part of the body being scanned also appeared to be a factor), but is when referred by a consultant.

As mentioned above, the only way to be sure is to ring.

coylemj

https://www.boards.ie/discussion/comment/120975935#Comment_120975935

That's a fair point - why would medical insurers fork out money for private A&E when you can go to the one in your local public hospital and get treated for free?

I'm not saying every medical insurance policy excludes private A&E but I can't imagine that it's covered by every policy. Most policies have some cover for the minor injury clinics but I can see how the insurers would prefer their policyholders not go near a private hospital A&E. Where you're liable to be referred to all sorts of expensive scans.

Jim2007

https://www.boards.ie/discussion/comment/120976668#Comment_120976668

Well generally speaking the policy holder has an obligation to minimise the expense to be paid by the insurance company. I know of cases here (Switzerland) where health insurance companies have refused holidayers expenses in case where the costs should have been covered by the EHIC and they either forgot to bring it with them, did no tender the card etc...

coylemj

https://www.boards.ie/discussion/comment/120976809#Comment_120976809

If your obligation is to minimize the expense to your insurance company, nobody would ever cross the threshold of a private hospital.

People go to private hospitals and consultants in order to avoid long queues, that's the whole point of having private insurance. If you can go private for non-emergency treatment, then, assuming it's covered by your policy, why not for A&E as well?

odyssey06

Probably the Beacon would have been able to explain it for you also, to echo @coylemj .

To give you an example, this is how Mater Private describes it:

Patients with health insurance

• Some insured patients may have no further costs relating to admission; others will have an excess/shortfall amount on their plan. 
• Your level of cover will be verified. Our team will take you through the costs before confirming your admission.
• Depending on your health insurance cover, payment of excess/shortfall may be required. This will be taken at admission. 

https://www.materprivate.ie/our-services/emergency-care/emergency-department/pricing-and-Insurance-cover-emergency-department-dublin

NeutralHandle

Thanks for all the replies.

I spoke on the phone to a triage nurse and they were helpful and able to tell me what would and would not be available but they didn't know about insurance cover.

I'd forgotten about this thread. I went to a clinic that provided the same services I need and which was explicitly covered.

DubLad69

https://www.boards.ie/discussion/comment/120978736#Comment_120978736

It may be different with VHI, but I asked Laya a similar question before attending a private A&E. It was basically treated like a consultants visit. So they refunded 75% of the cost of the initial charge as a consultants fee. Then the directly paid for some scans, but I had to pay and claim back for others.

I think all of the private A&Es have a cap of around €650, so no matter what you don’t pay more than that, and that max cost would be assuming your insurance doesn’t cover any of if. If you admitted to the hospital, you only have to pay the initial charge.