When you need us, we’re there

February 21, 2010

The VHI pride themselves on being there when you need them. I’m due to undergo revision surgery in the UK next Friday. The arrangements have been made, flights and hotel are booked but if the pen pushers in the VHI don’t get their act together, it will all be cancelled. Facing surgery is never an easy task but when you have to fight to get insurance cover for it,  it can be soul destroying. Surely it’s not right that a health insurance company can hold you to ransom like this?

People associate VHI Healthcare with excellent hospital cover. I’ve been insured with them since childhood and with my medical history, it’s fair to say that I’ve given them a good run for their money. With medical costs soaring, holding private health cover should offer peace of mind. However, should you find yourself in a position where you require treatment that is not available in Ireland, be warned! There is no guarantee of insurance cover.

No matter what level of insurance you hold, you will be made to grovel for treatment abroad by a process called ‘prior approval’ and if you fail to tick all the right boxes, cover will be refused. What really bugs me about this process is that it interferes with patient autonomy and the doctor-patient relationship. The VHI make the decisions.

The VHI state in their terms and conditions that “VHI Healthcare does not provide cover if a member travels abroad specifically to get treatment. However, in exceptional circumstances and subject to prior approval and satisfaction in full of specific criteria, we will pay up to the plan amounts outlined in the Table of Benefits.”

I was first sent ‘abroad’ for surgery in 2007 as treatment options in Ireland, had run out. The VHI subjected me to the process of prior approval and despite meeting all the specific criteria, my application for funding was turned down. This caused untold stress at a time when I was facing major surgery. The funding was subsequently granted on appeal and the operation went ahead as planned, in Nottingham.

I was referred back to the UK last year to undergo further radical surgery. Again, the VHI insisted on prior approval and again my referring consultant was asked to complete an in-depth questionnaire and supply academic evidence to support the proposed surgery. On this occasion, funding was sanctioned on the first attempt but the VHI kept me on tender hooks right up to the week of surgery.

Two weeks ago, I travelled back to Nottingham for a consultation with the surgeon who last operated on my head. I was referred back to him with a post-operative complication which has failed to respond to treatment in Ireland. The surgeon advised that some revision surgery is required. On contacting the VHI on my return, I was informed that prior approval must be sought for any surgery outside Ireland.

I have spent the last 2 weeks trying to get the revision surgery ‘approved’ in time. If it has to be cancelled, I will have to wait another month for surgery. On phoning the VHI last Friday, I was informed that I would be notified by post of their decision. When I reiterated that the matter is urgent, I was asked to phone again on Tuesday. That’s two days before I’m due to travel to the UK and there is no guarantee that my application will be approved.

“When you need us, we’re there”

Well, I need the VHI now so where the hell are they?