When you need us, we’re there

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?

12 Responses to When you need us, we’re there

  1. achelois says:

    How incredibly stressful I am so sorry. What happens i ask myself should one be so incapacitated that it proved impossible to maintain appropriate communication with this company. Good luck Steph.

  2. Steph says:

    achelois – Thanks! I don’t normally do stress but because I’m familiar with the way the VHI works, I know I’ve reason to be worried.

    You would think that as I’ve a track record of needing referral to Nottingham that the VHI would take this into account but NO, that would make life far too easy for the patient. My referring consultant is really annoyed about the situation I find myself in and has written to the VHI to make the point that having sanctioned the original op, they cannot refuse revision surgery. Still, the wheel of process continues to turn.

    If I choose to ignore the VHI and proceed with surgery, no funding will be provided.

  3. Bendy Girl says:

    Oh Steph, what a horrid situation! I hope you get the approval through asap BG Xx

  4. Annb says:

    Could I be my usual old cynical self here and suggest the fact that there is still state involvement in the VHI have something to do with their inefficient workings? As usual paperwork comes before patient welfare. Poor you Steph it is exhausting having to battle for your rights when you have enough going on with your medical complications. Deep breaths…. Good luck! And if you need a telephone Rothweiler for hire, I’ve got loads of experience and lots of bad references from the HSE – If I can help, just call! (or bark really loudly!) 🙂

  5. Grannymar says:

    Thinking of you as you wait for word!

  6. Steph says:

    Bendy – It is a horrible situation to be in but at the same time, I’m very aware that it would be worse if I didn’t have any health insurance. At least I’ve got some choice in the matter.

    Annb – It’s exhausting indeed. Instead of conserving energy for the surgery, I’ve had all my time taken up with dealing with red tape. Patient welfare does not feature in the prior approval process. It’s all about ticking boxes to save money.

    Here…join the club! 😆

    http://rottweilerclubofireland.com/

  7. Steph says:

    Grannymar – Sorry, I just found you in the spam bin.
    I wonder what you did to deserve that? 🙄

  8. Annb says:

    http://rottweilerclubofireland.com/ thanks for that link but seriously, Steph I’m much scarier than any of those puppies!

  9. Nancy says:

    Good luck, Steph. We are all on your side and hope the Insurance company is,too…..

  10. Steph says:

    Annb – Tomorrow is another day. Let’s see what it brings and if I need a Rottweiler, I’ll be on to you!

    Nancy – It’s gives me great comfort to have yours and everyone’s support. Fingers crossed! Cousin Steph x

  11. Maureen says:

    Hi steph, i wonder can i get some advise from you about prior approval with vhi, i am trying to get surgery in the uk, it is provided here at present but it is not as advanced as the option in the uk, vhi have refused and i have appealed with all relevant info and again a rejection, can you advise me as to how to proceed.

    • Steph says:

      Hi Maureen

      I hope it was helpful for you to find that you’re not the only one fighting the VHI for prior approval for surgery 🙂

      I was appalled by the way the VHI handled my various applications. After my last op in the UK (which they did fund in the end), they actually apologised to me (in writing) for the way that I’d been treated in the lead up to surgery. I was told that my case had been brought to the attention of management at VHI and was now being used as an training example of “How NOT to treat the customer” !!!

      I’m sorry to hear that your 2nd application has been rejected. The first thing you must realise is that the VHI will always try to find ways to refuse funding, patient welfare doesn’t enter into it. I suspect their attitude is that as the surgery is available here, you should be grateful they will cover you for it here. In other words, “put up and shut up”.

      I had a friend who needed innovative heart surgery a few years ago, at a specialist unit in France. Again, the surgeons here had run of options to treat him so they referred my friend for more advanced surgery outside the country. The VHI refused to fund the op in France so my friend threatened them with legal action via his solicitor and they eventually coughed up full funding!

      My approach to dealing with the VHI is to ring them every day while I’m waiting for a decision from them as this keeps them on their toes. I’ve heard every excuse in the book so these days, if I fax anything to them, I follow it up with a phone call to ensure they’ve received it.

      I’ve now been provided with a direct line to a Customer Support Officer on the Claims Product Team, for my own personal use when dealing with the VHI.

      My advice to you would be to phone VHI and insist on being put through to someone on the Claims Product Team to discuss your application. Otherwise, you will just continue to get passed around by the team in the VHI call centre.

      I wish you the best of luck with it and indeed, with your surgery in due course.

      Regards,
      Steph

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