A horrified reader got in touch with us last week to highlight how VHI, the State’s largest private health insurance provider, point blank refused to allow his recently widowed mother in her 90s cancel her policy outside of a renewal period despite the fact that she has just entered a nursing home and will never again need private healthcare.
He said that his parents had a policy with VHI for “the guts of 50 years” and like many people of their generation “stuck with [VHI] and refused to change providers”.
Our reader took his dad off the joint policy at the last renewal as he had Alzheimer’s and was in a nursing home.
He passed away during the summer and our reader’s mother has recently gone into full time nursing home care so, he says, she doesn’t need VHI.
Recently widowed woman (92) in nursing home must continue to pay for cover, VHI says
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“She is 92 and even with Fair Deal needs all the help financially that she can be get,” he says. “So I rang today to cancel her VHI and was told that moving to a nursing home was not an acceptable reason and that she couldn’t cancel until the 12-month policy duration has elapsed.
“When I asked what were considered acceptable reasons, I was told that changing job or moving country were some examples. So her dramatic change in personal circumstances, losing her husband and moving out of her home are not considered acceptable. I think it’s extortion after 54 years for them to treat her this way at a time when she really needs the money. I was told I can appeal but honestly I’m not holding out much hope.”
It seemed very unfair to us so we contacted the company.
A spokeswoman said that the contracts are for a 12-month period and “people are free to cancel their cover at their renewal date”.
She said they could also cancel their health insurance mid-term and with immediate effect if they die, move abroad, lose their job or if they are separated or divorced over the course of the contract.
“Moving to a nursing home is not one of circumstances we permit people to cancel their cover midterm,” the spokeswoman said. “Many people choose to keep their health insurance in place in case they may need it and we have many cases where residents of nursing homes avail of different benefits on their plans and are moved from the nursing home to hospitals for medical procedure in private facilities.”
She said she understood that some people will chose to cancel cover if someone is going to a nursing home “but we cannot set this as an exception to our 12-month contract . If someone wants to cancel their policy at their renewal date that is their choice, and we will facilitate that at their renewal date . They may also choose to change the plan that the person is on because they are in a fulltime nursing home, again we can do that at their renewal date . We encourage our members to complete a fact find which is a set of questions with our trained agents over the phone or online, to find a plan that’s suitable for their health needs and budget.”
She said that in the case we highlighted “we are happy to talk to the family and look at their case on an appeals basis”.
As our reader says he doesn’t hold out much hope for that appeal.
We got in touch with a doctor with considerable experience of working with older patients who did not buy the VHI response for one second.
“In my experience, most people in Ireland entering residential care, are at least moderately if not severely frail, with many living with an element of dementia/cognitive decline,” she said.
“Attending appointments/scans has often become burdensome and in many cases no longer adding value to their life. And I think this is a key point, these are not a group that are in a position to organise nor be vocal advocates for themselves and some (or many?) may be paying policies and other bills unwittingly.”
She also asked “what value or tailored cover do insurance companies really offer people in their 80s and onwards? For example I have seen insurance companies decline cover for the likes of a PET-CT brain scan for a dementia diagnosis in someone living in the community – a very prevalent and relevant disease at this age – but will cover one for a (usually younger) patient with a cancer. They refuse to cover care in hospitals if it is ‘only’ for physiotherapy etc. Instead of seeing this as a vital clinical component of comprehensive geriatric care to restore function in the older person after acute illness, it is not valued in the slightest by insurance companies.”
The doctor said that for “a cognitively robust older person who wants to keep a certain amount of access to private care, I am of course fully supportive. Perhaps the numbers of older adults being taken advantage of by insurance companies in this type of situation are small but I think it should be considered a very valid reason to cancel, and not glossed over.
“Unfortunately this transition point in people’s lives and their associated financial vulnerability, is an area devoid of good research, and this group are still forgotten by the rest of us in society – despite what we should have learned during the pandemic.”
