HSE re-examining patient refunds for overseas treatment after Ombudsman criticism

Hundreds of patients who were refused reimbursement of their treatment overseas by the HSE are having their cases re-examined following criticism by the Ombudsman.

Ger Deering said the cases of more than 200 patients seeking reimbursement for overseas treatment are being “relooked at in a positive way” since he published a report criticising the HSE earlier this year.

The HSE repeatedly refused to reimburse the legitimate expenses of patients who had necessary medical treatments in other countries and this forced many of them into debt, the report published last April found.

It accused the HSE of adopting an “unreasonable and inflexible approach” to the administration of EU and Northern Ireland cross-border health schemes. These allow patients on public waiting lists to get treatment abroad, the cost of which is then reimbursed to them.

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Addressing a patient conference on Monday, Mr Deering said his issue was not with the schemes themselves but with how they were being administered by the HSE. Many applications were turned down on a “technicality”.

Eleven out of 21 patients who were refused a refund of their treatment costs over alleged inadequacies in the referral letters from their doctors have had their cases overturned and been given refunds, he said.

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In some cases, the HSE had refused to accept an email referral of a patient by a GP; in others, the application for reimbursement was refused because the referral had not gone to a specific consultant.

One patient said they hit “rock bottom” when the HSE refused to refund the costs of treatment they had undergone overseas. “I was made to feel like a liar, a criminal, like I was trying to steal money that wasn’t mine,” the patient told the Ombudsman’s office in a letter. “The difficulties I had in getting a refund resulted in a relapse in my mental health which spiralled and forced me back into rehab.”

This patient has since received reimbursement.

Proof of payment was a “big issue” for many patients, Mr Deering told the Irish Patients’ Association conference. The HSE required the medical bill to have been paid by the patient herself. One woman was refused reimbursement after her credit card was refused in the overseas clinic and her husband paid the bill; the HSE deemed her not to have funded the treatment.

Mr Deering warned that having an overseas pension can have “implications” for applicants. In one case, a person who had previously had a hip operation in the UK applied to have a second hip operation there. When the HSE found the person had a British pension, it rejected the application and sought to claim back the cost of the first operation.

After intervention from the Ombudsman’s office, the HSE agreed not to seek money for the previous operation. Since then, it has agreed not to chase 11 people for repayment of earlier operations.

The Ombudsman said he was “extremely impressed” with the new HSE chief executive Bernard Gloster, who has agreed to implement all 21 recommendations in the report. The HSE is now implementing the cross-border schemes with much better outcomes.