Health Insurance Uncovered: 'People who've had an accident abroad call us with high medical bills but we just can't help'
What kind of cover do you have in A&E - or while travelling abroad?
Having a health insurance policy may not be enough to cover you if you fall ill abroad – or even ensure that you are given private care in an emergency situation.
People who disclose that they have private health insurance when they attend A&E are charged for private cover even if they are getting public care, according to Ireland’s leading health insurance expert.
"Someone will approach you and ask you to sign a form to say you have private health insurance. It may be the same public bed and you may see the same doctor, nothing will change except your insurance will be paying for it," Dermot Goode told independent.ie
In 2014, then minister for health James Reilly introduced a measure whereby health insurers would be liable for the full costs of their patients while they attended public hospitals.
A private patient in a public hospital can pay €813 a night for a bed in a ward (up to 180 nights) or €1000 for a private room. This is in contrast to public patients costs of €75 a night, capped at €750 over a twelve month period.
Patients with private health insurance admitted to hospital via A&E are asked to sign a form declaring where they are a public patient, although they are not obliged to declare as private.
Declaring as private won’t necessarily mean that the patient will get a different level of service than in the public sector. It does mean that your insurer will be charged considerably more, though, a cost that has been suggested as putting more pressure on premiums.
"Every patient is entitled to get public treatment at €80; this hospital charge does have a direct impact on the health insurance industry," Mr Goode said.
“Unfortunately, if you want to make sure you get the accommodation of your choice, you have to go to a private hospital. So if you are private, you are best off going to see a GP and getting referred to a private hospital. You'll get seen properly in a few days.”
With insurers obliged to pay the costs of patients who declare, public hospitals are also more likely to keep a patient in for longer than is necessary, according to Mr Goode; another factor that could be impacting rising insurance premiums.
"In the case of the private hospitals, the insurance companies are actually quite strict, with 65pc of procedures carried out as day cases," he said.
"If a private hospital, in comparison to a public hospital, keeps the patient in for longer than is necessary, they will not be paid in full."
What cover do you have if you fall ill abroad?
While there is some debate about whether you should declare as private in an emergency situation at home, having a health insurance policy might not be cover enough if you are unlucky enough to fall ill abroad.
Some holiday makers prefer to opt for a travel insurance policy or the European Health Insurance Card (EHIC) while travelling abroad and some believe that their private policy will provide the essential cover. However, Mr Goode believes that all three types of cover are required.
"Most plans have emergency medical cover while you are travelling abroad but it is important that you are admitted as the plans cover admissions only,” he said.
Most insurance policies cover up to a value of €55,000 - €100,000 following an accident or emergency, which may not be adequate if the patient requires treatment in a hospital in the US, for example.
Thus, carrying the EHIC card - designed to cover public hospital treatment in the EU - and taking out a travel insurance policy is also advised. But Mr Goode warns that the devil is in the detail here.
"Be careful when you are purchasing a travel insurance policy; one of the questions they will ask is if you have private health insurance. If you say yes, it will bring the premium down, but they will only cover the excess after the health insurer pays out, they will only cover the costs after that."
Those travelling in a matter of weeks are advised to check with both the health insurer and the travel insurer that will be providing cover.
"Call and ask them about the length of cover while abroad, tell them where exactly you are going, how long you will be staying and what activities you plan to do – and what excesses there are.
"At least if one of you gets sick on the holiday, you will then know exactly what to do."
'We would love to be able to help... but it is just not possible'
The Kevin Bell Foundation aims to alleviate the financial hardship of bereaved families repatriating the body of a loved one who has died abroad in sudden or tragic circumstances back to Ireland.
The group's Colin Bell has come across cases of people who are facing financial difficulties due to high medical bills while abroad.
"We only repatriate bodies but we get an awful lot of requests from people who are in hospitals facing big bills and we are unable to help because it is outside our remit," he said.
"We get a lot of requests from people who have had an accident and they are not covered by insurance."
On average the Kevin Bell Foundation gets about one to two calls a month from people requesting assistance on their medical bills - but there is nothing that they can do, said Mr Bell.
"It’s annoying that you can’t do something but we are the only charity that repatriates, we would love to be able to help in the other cases but it is just not possible."
Mr Bell warned that in the US or Canada, especially, people who are ill and want to get home and have no health insurance cover can face massive bills.