Health insurance cover conundrum

A reader called Liz contacted us about a problem with a health insurance claim she lodged with Laya Healthcare. "The issue stems from a five-night stay at Holles Street in May," she says.

She was put into a private room in the hospital, where she spent five nights. The doctor’s fee came to €1,528, which was covered in total by her insurer, so no problem there. The hospital costs came to €4,000 and this is where the issue arises. “There’s a shortfall of €935 for the room cover. So on the statement it says I owe €935, and the explanation is: ‘The accommodation occupied is higher than the scheme covers, therefore you are liable to pay a shortfall. If this amount has not already been paid, please pay it directly to the hospital’ ”.

“This surgery was elective, and the past 12 months have been extremely stressful and an emotional rollercoaster,” she writes. “I found Laya staff very helpful on the phone. I phoned a number of times in February, March and April, with various queries and to sort scans, MRIs etc.”

When she realised the full extent of the surgery she would need to have, she phoned to confirm that she would have cover at the hospital on that ward in a private room and with that surgeon. “I was assured I would. My cover is for a semi-private room, but the particular ward in Holles Street only has five private rooms and a public ward. Given a choice, I would have gone for a public ward if I’d know there’d be a big bill involved at the end of it. Anyway, I would appreciate any advice or guidance on the above.

In response Laya said our reader had made contact with it in February to check her level of cover for Holles Street. “We correctly advised the member that she had cover up to a semi-private room in public hospitals, which included Holles Street. This means she was fully covered for accommodation in both public wards and semi-private rooms in Holles Street hospital.”

A spokeswoman said it was “not involved in discussions that take place between a member and a hospital in relation to the accommodation options available for an admission. The member needs to ensure their health insurance scheme provides adequate cover for the accommodation they are offered and/or occupy.”

It said that if a hospital does not have a room available based on the level of accommodation covered by a member’s scheme, they can either stay in a public ward, pay the shortfall or have the hospital waive it.”

Public and private patient prices

We got a second query in connection with health insurance from a reader called Noleen. “I know there has been lots of discussion about private patients and public hospital beds lately, and I would just like to add my piece,” she writes. “I was hospitalised in August for five days, the first 24 hours in an emergency department. I was not asked to sign anything or asked if I had cover and I received no bill. I was transferred to another hospital for the next four days. Again nobody asked me whether I had insurance cover or not. Subsequently I received a bill for €300 which is €75 for each day.”

She then contacted her health insurers to ask them to pay this “but alas they cannot. Instead I can contact the hospital and give them my insurance details and let them claim from my health insurers to the tune of somewhere close to €4,000 for the same bill. Surely it would make more sense for insurers to pay initial bill?”

Of course it would make more sense. But that is not what happens in Ireland. Patients admitted to hospital without health insurance are put into one administrative category, which sees them hit with a €75 per night bill. Patients who have health insurance are put into another administrative category, which can see them hit with a bill of up to €1,000 night; the charge is set by the State depending on the hospital. Both patients might get exactly the same treatment and stay in exactly the same ward but one will end up paying more than €900 per night more – or at least their insurer will.

Effectively what is happening is the private health insurance market is funding the public sector in this case. In the past, as many as 50 per cent of people with private health insurance were treated for free in the public system, which was equally ridiculous.

The problem of shrinkflation

We have had cause in the past to highlight the problem of shrinkflation. The term describes a now common practice among big-name manufacturers to shrink the stuff they sell us while keeping the price high. Kieran Baker got in touch with what he believes is an example. A 500g box of Kellogg's Corkflakes is now a 450g box.

We contacted Kellogg’s, which confirmed that the pack size has been reduced. “However, we also reduced the price, offering even more value to our customers. The pack size has reduced by 10 per cent but the shelf price has reduced by around 25 per cent. The cheaper price is available in most supermarkets but Kellogg’s can’t control the price that all retailers choose to sell these packs at.”