Some Day…

Do you have health insurance or is this something you’ve put off until another day? If you’re young, fit and healthy, the chances are you’ve never really given your health much thought. Why would you worry when you haven’t had to face huge medical bills? With the rapid privatisation of our health service, health care in Ireland is becoming more like the 2-tier system in the States. Those with insurance will get top dollar care while those without, will suffer.

About five years ago, my GP sent me urgently to the A&E department of our local public hospital as I had developed acute abdominal pain. I was processed by the triage nurse and allocated a trolley in a cubicle so that the doctors could assess my condition. Once my blood tests had come back from the lab, the decision was made to admit me overnight in case I needed to go to theatre. I was put on a drip (nil by mouth) and lined up on a trolley in the centre of the department along with scores of others, in a queue for a bed. I hit lucky on that particular occasion and was transferred to a ward in the middle of the night. By the following day, my abdominal pain was severe (my intestine was blocked by an abscess) and it was decided that a CT scan should be performed to ascertain if surgery should be performed. I was started on intravenous antibiotics while I awaited the scan but kept fasting in case surgery was required. This was bearable until a harassed looking junior doctor appeared at my bedside to announce that the CT scanner had broken down and was awaiting repair. By the following morning (day 3), the scanner was still out of action and my situation was beginning to look very bleak. Around lunchtime, the same doctor rushed in and asked me to confirm that I had private health insurance. I did, thankfully, so the decision was made to transfer me to the private hospital, to avail of their scanner. The scan confirmed a diagnosis of acute diverticulitis with obstruction of the bowel but it was seen to be resolving so I could finally be taken off the emergency list. Had I not had health insurance, I hate to think that I may have ended up having investigative surgery as no scanner was available to make the diagnosis. Please don’t get me wrong here, I received excellent medical care during my 10-day stay in this public hospital and was very grateful for it. However, the system was clearly in overload and patients were suffering as a result. My insurance was worth every penny to get the care I needed when I needed it most.

Health insurance is a complicated business. It’s designed this way so that the insurers are protected against excessive charges by private doctors and also to restrict patient benefits. There are three main insurance groups in Ireland and they each purposely have slightly different health plans so that it’s almost impossible to compare like with like. I have spent vast amounts of time over the years, trying to work out which plan offers the best deal for my family. It was years before I realised that each member of the family can hold a different policy to meet their individual needs but don’t expect your insurance company to tell you stuff like this, ‘cos they won’t. I review our policies every year to see how we can reduce costs yet still retain adequate cover for both emergencies and day to day care. There are all sorts of clauses to catch you out, so be careful what you change. And remember, it’s too late to look for insurance when you’ve already become ill because penalties will abound. You have to put in the work yourself if you want to see improved benefits. I long ago gave up hoping that an apple a day would keep the doctor away.

10 Responses to Some Day…

  1. Bainon says:

    Oh Steph thanks for the reminder, I needed to see whether Adam was still covered on my family health insurance! (is until he’s 25 as long as he lives at home and isn’t in a defacto relationship)

    Yep, sad but true, I can’t do without it. We’ve had very few hospitalisations in our lives, tonsils, babies, a hernia for Ads and asthma treatment for Clare, my hysterectomy which alone would have been considered ‘elective’ had I not had cover. The whole thing cost me about $100 in a Private Hospital and was over and done with very quickly by the surgeon of my choice – the peace of mind frankly was worth the premium. Unfortunately, not everyone can afford the premiums and suffer accordingly. (Three days with acute pain is not acceptible by anyone’s book!)

  2. Bainon says:

    Ooh sorry my name has changed . . .sounds a little exotic!

  3. Steph says:

    Hello Bainon 😆

    When Robin left for London 2 years ago, I didn’t cancel his insurance on our policy for 6 months as I waiting for him to make his own arrangements through the company he was employed with. When I finally rang our insurance company to cancel his policy, they told me he wouldn’t have been covered in London by his Irish insurance as he wasn’t resident here. Doh!

    So when Robin set off for Chicago in June, I insisted that he take out a new policy of his own with extra travel insurance included, to cover his movement around the States. One simple trip to ER with a broken wrist/ankle would have cost more than his insurance for the year. You cannot afford to take risks with your health in the States.

    I agree that many people cannot genuinely afford health insurance but there are many more who will tell you that they cannot afford it yet they go abroad on holiday several times a year. It’s all a question of priority really and I agree with you, I rather have the peace of mind anyday.

  4. Oh lord, don’t even get me started on this subject. I worked for a huge life assurer for many years – medical aids etc were part of the package and then I ended up working in what was known as the Employee Benefits section – marketing ooh er, guess what, health plans, amongst other things. To this day, however, I find that I cannot understand a word of what the marketing of most plans says (I’m relieved to know, sort of, that not even top actuaries can understand it!). I am quite convinced it’s designed to discombobulate the average person, never works in the individual’s favour, and is fundamentally a rip off dreamed up by doctors, pharmaceutical companies and health insurers. It works for chronic medication (yippee) and major medical expenses (sort of), unless of course you’re willing to pay them a gazillion pounds every month in which case it will work for everything, but by then you’ll be in the poor house, so what does it matter…
    Erm, rant over, although I’ve only just begun!
    I dread to think what I’m going to have to deal with in the UK – I’ve never been without private health insurance… I can see serious investigation will be needed, and I already know there will be penalties and exclusions. Sigh.

  5. Lottie says:

    Steph – I am guilty of not have insurance. When I changed jobs last eyar – I was told that HI was included in my package. It wasn’t and I have just got too tired of fighting for it. So I am totally exposed.

    The thing is the cheapest I can get a quote for myself and my partner is 1100 a year for pretty basic cover. When you compare that to the amount of money we no doubt spend on going out and enjoying our selves (while wrecking our livers, hearts etc) then it’s very little but Im stingy. I haven’t needed a hospital since I was 19 and the idea of paying out thousands of euro makes my tummy hurt.

  6. Steph says:

    AV – I very much enjoyed your rant, thanks 😀

    It always riles me when I hear the radio ad for my insurance company…

    “we’re here when you need us”

    I’m sorry but they’re often not ‘there’ when you need them most. In fact they do their utmost to make life difficult for you if your claim doesn’t fit their neat little boxes. It seems you can get full cover to have your bunions fixed but if you suffer from something a little out of the ordinary, you have to fight your corner.

    I have spent days trying to get the best offers online and then when I ring the company to double check, there’s always a hidden clause or penalty. I’m convinced that these days when I phone, a a flashing alarm goes off in customer service to warn everyone to be on lookout for my awkward questions!

    Lottie – the last time I wrote about health insurance, you commented ‘some day’ and that’s what stimulated this post. I totally understand your reluctance to fork out good money on an insurance policy when you’re fit and healthy. But then again, who knows what lies ahead? Insurance not only gives you peace of mind, it offers you choice.

    I’m presuming that the quote you gave me is for 2 adults i.e. €550 each annually? My son forked out something similar and while his IP cover is basic, that’s okay as he’s unlikely to need it at this stage of life. More significantly, we’ve chosen a policy that gives him good cover for day-to-day medical expenses. If I told you that a single out-patient CT scan can cost in the region of €300-400, would that change your mind at all? And that’s after you’ve paid a consultant €150-200 to request the scan and then another similar amount to return to hear the result of the scan. Private medicine is big bucks and while you may say now that you’ll go the public route if your GP tells you you need to see a specialist, you might change your mind when you hear the length of the waiting list.

    If you’d like to ask me more questions, please don’t hesitate to get in touch as I’ve learnt a fair few tricks of the trade after many years of fighting my corner.

  7. Knipex says:

    I have had health insurance of my own since I started working. It is expencive and even more so now that I have my wife and son included on the policy. For years I was paying and paying and never made a claim and was actually considering dropping it untill one day I had a visit with my GP and he requested a colonoscopy. I waited 2 weeks for my appointment. Once it was over my treatment got under way and my mind was put at ease.

    My brother has no insurance was was waiting months.

    An MRI costs over 500 Euro if you go private but my insurance covers it. I get 50% of my GP costs back.

    I wouldnt dream of giving it up now. They probably make money off me every year but when you need it having insurance does remove alot of stress.

  8. Laura says:

    I am insured up to the nines and the tens but they refuse to cover certain things .. important things, lifesaving things – CAT Scans. I have a folder of correspondence and could write a book about my insurance nightmare, daymare and neverendingmare.

  9. Steph says:

    Knipex – thanks! One tip for you re having the whole family insured. There’s really no point in having your son insured for single room accommodation as…
    1. Children’s hospitals tend to offer public/semi-private accommodation only (single rooms are kept for isolation purposes and the very sickest).
    2. Children do best in company and so do parents for that matter (being stuck in a single room all day with a bored child, is miserable for everyone).
    I made the mistake of having both my children covered for years on the same policy as myself and my husband. It was only when my daughter was admitted to a children’s hospital for the first time that I realised the error of my ways. It makes more sense to choose a policy that offers good OP cover for children e.g. GP visits, dentists etc. as this is where the yearly costs can sore, but also offers basic IP cover.

    Laura – sorry to hear you’re getting hassle from your insurance company. You really could do without it, couldn’t you?

    I once had a row with my insurance company over cover for OP intravenous treatment. I had a central line inserted and had spent five days in a private hospital having my condition stabilised. As my youngest child was very small at the time, I pleaded to be allowed to continue my treatment from home by attending the hospital 3 times a day for IV infusions. This request was granted as I was a regular patient at the hospital. Half way through the rest of the treatment, the pharmacist at the hospital rang me at home to say that she needed me to guarantee payment for the infusions. When I queried this I was told that my insurance company did not recognise my treatment as an out-patient. They were perfectly happy for me to be re-admitted to the private hospital to have this same treatment as an in-patient and were prepared to fully cover the huge charges incurred but they refused me ANY cover as an OP. My specialist intervened on my behalf and eventually the insurance company relented and covered my treatment as an OP but not before they’d caused me a great deal of unnecessary stress.

  10. […] I freak myself out. Between Steph warning of the dangers of not having health insurance , Morgor talking about moles and Willknotts […]

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