Thursday 20 June 2019

Must my father go private after pressure to sign form?

Your questions answered

Email your questions to lmcbride@independent.ie or write to 'Your Questions, Sunday Independent Business, 27-32 Talbot Street, Dublin 1'. Stock image
Email your questions to lmcbride@independent.ie or write to 'Your Questions, Sunday Independent Business, 27-32 Talbot Street, Dublin 1'. Stock image

Dermot Goode

Q: My father, who is very elderly, has cancer. His nearest hospital is a public hospital. He recently became very sick with his cancer and has just been admitted to that public hospital. As my father has private health insurance, the hospital insisted that he sign a form waiving his right to be treated as a public patient. I was not in the hospital at the time my father was put under pressure to sign the form and am very annoyed about this. Furthermore, there has been no difference in the standard of care my father received after signing that form - he continues to be in a public ward. Also, as my father only got private health insurance in recent years, he still has a year to go before his policy covers him for cancer treatment in hospital. Does this mean that he will now have to foot the full bill for his hospital stay? He simply is not in a position to afford that. Can I do anything to undo the consequences of him signing that form? Lily, Co Dublin

The first point to note here is that your father is entitled to be treated in any public hospital as an ordinary public patient just like every other citizen. His health insurance cover is his business and this only becomes relevant if he is admitted as a private patient for his treatment from the outset - or if he decides to switch from public to private to get a private room or to be under the care of a specific consultant. Otherwise, he can remain a public patient for the duration of his treatment and the only charge he is liable for is the €80 per night public hospital charge - which is capped at €800 in any 12-month period and is fully covered by all health insurance plans.

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Given that he is now being billed as a private patient and he hasn't yet served all waiting periods, you are right to be concerned. If there is any question that the illness was pre-existing (that is, present prior to him joining private health insurance), then the insurer could reject the claim - leaving your father liable for all costs. While every public hospital is entitled to offer every patient with health insurance the option of changing to private treatment, they have no right to insist that patients use their private cover. One has to also question the practice of approaching sick people - especially the elderly - and asking them to sign these forms at a time when they are most vulnerable and will probably sign anything that is put in front of them.

I recommend that you engage with the hospital immediately and demand that your father's status be amended to that of a public patient from the date of admission. If the hospital refuses this, simply contact your health insurer and explain how your father was treated and it should then engage with the hospital on his behalf to resolve this for you.

Self-insuring health

Q: I'm in my fifties and have never had private health insurance before. I've never had any major health problems. I considered taking it out recently but the loadings don't make it worthwhile. A friend suggested I self-insure. How would I do that and is it a foolproof strategy? Tom, Co Kerry

This is a query raised by many older members thinking of joining private health insurance. If we assume that you are 55, this means you'll face a 21-year private health insurance loading which will add 42pc to your gross premium for the next 10 years. Self-insuring is definitely an option but it's a high-risk strategy and is absolutely not foolproof.

It assumes that you will be disciplined enough to put the funds aside each year and not dip into them - except for healthcare costs. It also assumes that you will remain healthy for the next five to 10 years and hopefully not have to draw down any of the funds - for example, if you set aside €2,000 a year for the next five years, this will generate a fund of just over €10,000. However, a hip, knee or shoulder replacement will cost about €15,000 with major cardiac surgery costing multiples of this - so the fund may not be sufficient to cover the total cost of essential medical treatment. On the plus side, all private hospitals such as the Hermitage, Beacon and Whitfield welcome self-pay patients and will work out a payment plan for them. Everyone has a different attitude towards risk and the self-pay route may be the only option for you but it's a high-risk strategy. Given that there are health insurance plans now available from about €900 per adult (excluding loadings) which cover public and private hospitals, I'd suggest you fully explore these first before abandoning the private insurance option. For example, you could consider the VHI One Plan 250, the Irish Life Health Benefit Plan or the Laya Essential Health 300 scheme. Also, you should bear in mind that the loading only lasts for 10 years - after which, it will be removed.

Arthritis cover

Q: I recently returned to Ireland to retire. I've had private health insurance here for the last four years. My left hip has started to give me trouble due to arthritis - and so I need a hip replacement operation. I'm worried that this arthritis might count as a pre-existing illness. I had a replacement for a different joint (as a result of arthritis) several years ago - when working abroad (and under a foreign private health insurance plan which I had at the time). Does any type of arthritis count as a pre-existing condition - or do insurers go by a specific joint at a time? The degeneration in my left hip is recent - as it only occurred during the last two years. Geraldine, Co Kildare

This scenario is quite commonplace and it's difficult to give a specific answer as claims will be assessed on the medical information provided by the GP and consultants. Firstly, you need to have five years of continuous cover in place to fully serve the pre-existing waiting period. After this, all pre-existing conditions should be covered by the insurer - subject to the terms of your policy. Any problems that were present before joining may not be covered as you only have four years cover in place.

As to whether the existing hip problem is related to the previous surgery, this will be determined by the medical evidence provided by your doctors and how this is interpreted by the medical doctors working for the insurers. Some would argue that the fact that you have arthritis already means this is a pre-existing problem irrespective of how this manifests itself. However, if you can prove that the current hip problem is a recent issue and if the medical evidence supports the fact that the degeneration in this hip joint only started in the past two years, I believe that this will be looked at favourably by the health insurer. You should now engage with your insurer and provide whatever medical information is required to have your surgery pre-authorised (that is, assessed in advance to make sure you're fully covered before booking the procedure).

Dermot Goode is a health insurance expert with totalhealthcover.ie

Email your questions to  lmcbride@independent.ie or write to 'Your Questions,  Sunday Independent Business, 27-32 Talbot Street, Dublin 1'. 

While we will endeavour to place your questions with the most appropriate expert for your query, this column is not intended to replace professional advice.

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