Sunday 16 December 2018

Private patients face hospital bills over insurers' row

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Dermot Goode: Expert warns against insurers’ ‘nit-picking’

Gavin McLoughlin and Charlie Weston

Private hospitals are warning patients they will have to pick up the bills for treatments as health insurers are increasingly refusing to pay.

Chief executive of the Blackrock Clinic James O'Donoghue said insurers are challenging patients' policies, the length of time they are spending in hospital, as well as pre-existing illnesses in order to reduce exposure to claims.

He said private hospitals have 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," Mr O'Donoghue said.

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.

Dermot Goode: Expert warns against insurers’ ‘nit-picking’
Dermot Goode: Expert warns against insurers’ ‘nit-picking’

Insurers representative group Insurance Ireland said health insurance companies "are thorough in managing their costs".

"Health insurers work to ensure their customers get appropriate care in an appropriate setting in line with clinical governance and medical best practice.

"In the interests of their customers, insurers negotiate individually with healthcare providers. In addition, they are mandated by the Central Bank of Ireland's Consumer Protection Code on how claims are assessed and processed."

Health insurance expert Dermot Goode said it would not be acceptable for private hospitals to bill patients who have cover for procedures.

"If claims have been covered up to now, it is nit-picking to say they are no longer going to cover them and pass on the costs to consumers," he said. "That is unacceptable."

But Mr Goode, of Totalhealthcover.ie, warned that many people are not fully covered for all procedures in high-tech hospitals like Blackrock Clinic.

He advised anyone using a private hospital to check in advance if their procedure is covered by their plan.

That echoes a campaign by Umbrella group the Private Hospitals Association (PHA), which has urged people with private health insurance to be more vigilant when renewing their cover.

PHA chairman Michael Cullen said increasing numbers of patents were facing higher "co-payments" - charges they pay themselves alongside the charges covered by their insurer - before being able to undergo procedures.

Mr O'Donoghue was speaking as the clinic announced its financial results for last year.

Revenues rose by around 3pc to €122m due to more patients.

But profits fell to €9.5m before tax because of what the clinic said was a refusal by insurers to match inflation in medical prices, which is being driven by more expensive drugs and the adoption of new technology.

Mr O'Donoghue said the clinic has been spending €16m a year on investments in medical equipment, but that reimbursement rates from insurers weren't matching increases in the clinic's cost base.

This put a question mark over further investment, he said.

Mr O'Donoghue did not single out any individual insurance company in his comments.

Irish Independent

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