VHI and Surgery cost cover

henke · 30-11-2022 5:43pm #1

Has anyone any experience of trying to claim for a procedure through VHI? It is to correct a squint and they started of telling me all costs covered (happy at this point) but proceeded to say:

They have a wait period of 5 years if its deemed as pre-existing condition on new policies? As I was born with then it must be pre-existing. I may be misreading this but essentially would need to have health insurance for a full 5 years with VHI before they would cover it or else pay full whack right now, even though I have a health insurance policy in place that I cannot avail of or get anything back on?

They said there is exemption if you had previous health insurance (which I did but finished 6 months ago - the probation period of new job to become eligible for company plan) but I think that is longer than they allow a break.

If it is as bad as I think I wonder can one upgrade the Health insurance to remove wait periods if it is a cost less than the procedure.

Any help/feedback appreciated?

wandererz · 30-11-2022 5:56pm

Their break in cover period is 13 weeks.

https://www.vhi.ie/downloads/terms-and-conditions/LIFCPM15

henke · 30-11-2022 6:24pm

Yeah that's not good if I'd known this I would have paid it over the break as previous health insurance had a few years.

coylemj · 30-11-2022 6:34pm

They have a wait period of 5 years if its deemed as pre-existing condition on new policies? As I was born with then it must be pre-existing. I may be misreading this but essentially would need to have health insurance for a full 5 years with VHI before they would cover it or else pay full whack right now....

The waiting period is there so that they don't have to pay out for people who take out a policy specifically to cover treatment they they know they will need in the short term. And then drop the cover when all the bills have been paid. Same applies to policy upgrades.

.... even though I have a health insurance policy in place that I cannot avail of or get anything back on?

This is simply not true. There are lots of procedures and treatments for which you can claim before the waiting period expires. Most of them relate to unforeseen illnesses for which you would need to join a long queue in the public system.

If it is as bad as I think I wonder can one upgrade the Health insurance to remove wait periods if it is a cost less than the procedure.

You have to be realistic here. The people who want cover which has no waiting period are typically the same people who need specific treatment tomorrow. Which means they will be lodging a claim very soon after taking out the policy. The premium will typically reflect this.

30-11-2022 6:50pm

Breaking health insurance cover is a mistake made by so many people, it needs to be prioritised over everything else to keep cover for as much as possible.

I had strabismus surgery as an adult, having been born with condition. It was covered, but unfortunately in my particular case the condition returned within the year of the surgery. He said he could do more surgery but no guarantees as mine is a neurological issue more than anything.

I have exotropia which is problematic and causes me a lot of imbalance issues, in my case associated with probably ADHD.

You could possibly discuss with ophthalmic surgeon waiting the 5 years before having the surgery. Generally a delay is not harmful, but of course you will naturally be keen to have benefits asap.

henke · 30-11-2022 6:52pm

https://www.boards.ie/discussion/comment/119940796#Comment_119940796

Yeah fair point I see what you mean and the logic in it and appreciate the feedback.It's a tad frustrating as I would have had 5 consecutive years with Laya up to May but wasn't clued in on waiting periods or the break period but my own fault I suppose.

I am wondering though will they cover any percentage of it ie some part of hospital fees (private hospital listed as one they cover) or would be typical that any day before 5 years I'd have to pay full amount and the day after 5 years they would cover the full amount ie could I get any help from the health insurance here. I will call and ask but just looking for thoughts?

henke · 30-11-2022 6:59pm

https://www.boards.ie/discussion/comment/119940877#Comment_119940877

Definitely a mistake and one I was certainly never aware of. Looks like I'd be short 11 odd weeks given the allowance of 13 weeks which could prove costly if I proceed now.

Yeah I know I could wait the 5 years but would be disheartening as I had full intention of doing this in the new year if I could get some help on it even if the full cost wasn't covered.

Yeah I was told there was a small risk it would return at a later date but yeah a year would be disappointing. Did you or would you get it again?

coylemj · 01-12-2022 1:06pm

I am wondering though will they cover any percentage of it ie some part of hospital fees (private hospital listed as one they cover) or would be typical that any day before 5 years I'd have to pay full amount and the day after 5 years they would cover the full amount ie could I get any help from the health insurance here. I will call and ask but just looking for thoughts?

I'm pretty sure the waiting period means no cover at all. When the waiting period ends, normal rules apply and your policy may or may not cover that procedure in full. A middle option is that it may cover a % of the claim or they may cover up to stated limits for each of the consultants. It will depend on the type of policy you have.

henke · 01-12-2022 2:03pm

https://www.boards.ie/discussion/comment/119943959#Comment_119943959

Yeah they told me my policy type covers entire hospital fee and surgeon fee so just excess payment. So it looks like its wait 5 years and have it all covered or get it sooner with zero cover. I would have hoped to be able to get something before 5 years that would make it a bit more affordable. Thanks.

01-12-2022 2:25pm

https://www.boards.ie/discussion/comment/119940917#Comment_119940917

Since the strabismus surgery I have undergone very major surgeries unrelated to that issue, so I’ve had enough of surgeries for the time being. The fact that it returned so quickly on me was dis outraging tbh. I’ve other sight issues too which in my case are very likely to have complicated it. I had both eyes done at same time, and my imbalance was and is considerable. One eye didn’t hurt at all after the op, the other was quite sore for a while, but that alone wouldn’t put me off. I was literally blindfolded for 24 hours after op and in the hospital 3 nights.

henke · 01-12-2022 3:13pm

https://www.boards.ie/discussion/comment/119944274#Comment_119944274

Jesus that does not sound fun. Hope your keeping ok now. It was mentioned to me there was a small risk of it returning in approx. 10 years but it could be corrected again by surgery, but if it it came back after a year I'd be fuming too which is making me reluctant to spend the few grand full price to get it done. At least if it was covered and didn't work out not massively out of pocket but obviously would still be disappointed.

coylemj · 01-12-2022 3:42pm

https://www.boards.ie/discussion/comment/119944559#Comment_119944559

FWIW, I had that operation as a child (multiples of 10 years ago!) and there was never any complications or the necessity for any follow-up i.e. it was done and dusted in one go. I was also fortunate in that, cosmetically, they got it right first time.

henke · 01-12-2022 4:03pm

https://www.boards.ie/discussion/comment/119944775#Comment_119944775

That is good to hear. I don't think mines is a complicated case. Yeah had my heart set on it so not sure I can wait 5. Not sure what to do. Will need to have a think I suppose.

Jim2007 · 01-12-2022 7:59pm

As someone who has not experience of Irish health insurance, I find this discuss strange, as I have been in Swiss health insurance most of my adult life...

The first thing is that it a defect at birth not a medical condition that developed over time, so it would not be covered by insurance over here in any case. It would be the responsibility of the state
The idea of the five year wait is to ensure that the new insurer is not on the hook for a developing medical condition, where as in this case it is a certainty that the new company will be on the hook for it, so making someone wait for an extra five years sounds harsh.

SuperBowserWorld · 01-12-2022 8:25pm

I have had major eye surgeries which I'm not going to go into here. For condition from birth. It's been an awful time to be honest.

So, the important thing is to find a good surgeon first to discuss your options, risks and costs. And to get peace of mind. You will have to pay for this. But insurer might cover half that as day to day expense.

Options:

- Surgery private in eye and ear and follow ups public.

- All private.

- You pay for the private stuff. It may be not as much as you expect and you may be able to afford it. The surgeries I had were less than or about a couple of grand each time, I was surprised how little the insurer had to pay. This was 2015 onwards. Maybe costs have gone up. Eye surgery is cheaper than heart surgery I guess.

- Wait for public. It might be less than eg. 18 months. Go to eye and ear hospital anyway and get out on the queue regardless. You will probably at least get some more info hopefully from a good surgeon at this point.

- Ask your company if they can get the insurer to forgo the waiting period for you. One company I was in ... the insurer did this for all employees.

- I did say surgeries. So, you may be lucky / normal or you may need follow on work ...

Get some prices from a good private surgeon for all of the options above and talk to your company and insurer.

henke · 02-12-2022 11:01am

https://www.boards.ie/discussion/comment/119945937#Comment_119945937

Thank you for this advice. It might be worth asking the company about that option anyway even if its a long shot. It was a private hospital I went to for consultation and they said risks were low with my case. Costs were just over 3k and that was split between hospital fees and surgeon fees. I would probably go ahead if I could retrieve some of that amount at least. Good advice on the public route as well it would certainly be less than 5 years you would hope.

SuperBowserWorld · 02-12-2022 11:08am

https://www.boards.ie/discussion/comment/119947719#Comment_119947719

You could also get second opinion and advice from another surgeon privately if you are worried. Maybe 200 quid and insurance should cover half as day to day expense.

Anyway best of luck 👍

VHI and Surgery cost cover

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