Tuesday 18 June 2019

Patients left to foot bill as insurers refuse to pay

One in 10 with health cover is having to meet cost of treatment

Stock picture
Stock picture

Charlie Weston and Gavin McLoughlin

Patients are being forced to pay towards meeting the cost of medical procedures despite having health insurance, an industry expert has warned.

Dunraven Health Services said there had been a huge rise in rejected, or partially paid, claims for treatments.

Dr Brian McManus, of the Dublin firm, which negotiates on behalf of hospitals, said one in 10 bills is not being paid, or only being partially paid.

This meant both public and private hospitals then had no choice but to bill the patients, he said.

"One in 10 claims is being pended, rejected or partially paid," Dr McManus said.

That comes after Blackrock Clinic chief James O'Donoghue said insurers were challenging patients' policies, the length of time they were spending in hospital, as well as pre-existing illnesses, in order to reduce their exposure to claims.

Mr O'Donoghue said private hospitals had traditionally absorbed the cost when insurers wouldn't pay the amount being sought. But the figures under dispute between the clinic and insurers had risen 300pc and this was "not sustainable", he added.

"Should this continue, we cannot guarantee that customers will not be forced to negotiate with their insurers about shortfalls following treatment."

He said he believed payment refusal was an issue for other private hospitals and that they too may be forced to pass costs on to patients.

Asked for a comment, Vhi, Laya and Irish Life Health all referred to a statement from their representative body, Insurance Ireland.

It said when there is a disputed claim, this is settled directly between health insurers and health care providers, and customers should not be involved or affected.

"If there is a question of eligibility, each health insurer is guided by their expert-led medical advisory teams in validating and assessing the claim in line with clinical governance and medical best practice," the insurance body said.

Insurance Ireland said insurers work to ensure customers get appropriate care in an appropriate setting, and if customers have queries on their cover, they should contact their health insurer.

In addition, private hospitals have admitted there is a problem with patients being hit for bills, because they are realising too late that they have to make co-payments for treatment, alongside their insurers' contribution.

A spokesman for the Private Hospitals Association said most health insurance members were not being forced to pay any aspects of bills for hospital treatments.

But it added: "The association and its 19 members are, however, very concerned that privately insured patients lack adequate cover in the key treatment areas of cancer, cardiology and orthopaedics.

"More and more patients are realising too late that their cover is falling short, and then face additional co- payments."

Irish Independent

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