THE VHI has been accused of steering cardiac patients away from costly but non-invasive treatments and of putting lives at risk by offering diminished cover for a highly regarded heart valve-replacement procedure at private hospitals.
The daughter of an 80-year-old man being treated at the Blackrock Clinic in Dublin has written to both the Minister for Health and the Health Insurance Authority to complain about restrictions on her father’s health insurance policy.
Ann Cusack said her father was advised earlier this year that he needed a heart valve replacement but surgery was ruled out as too high-risk. Doctors at the Blackrock Clinic said a relatively new heart valve-replacement procedure, carried out via a catheter, would be the safest way to proceed.
The man assumed his Plan B Options policy, taken out because of the high level of cardiac cover it offered at the State’s leading private hospitals, would allow him to have the transcatheter aortic valve implantation (Tavi) procedure.
It costs about €40,000 but when he contacted the VHI, he was told it had recently created a new class of cardiac procedures, for which they paid only half the cost of the procedure.
“When I called the VHI it took several calls to establish that they did not cover the operation as it was not a ‘listed’ procedure,” Ms Cusack said.
She said her father had been a subscriber for 50 years and “had little reason to make claims on the VHI” over that period but “despite this, my father was left in limbo for several months, all with the worry that he would have to meet the full costs of the operation”.
The clinic and the insurer reached an agreement that it would cover half the cost of the operation, leaving a shortfall of almost €20,000. “This is a very large sum and not money that he can easily afford, and while we, his children, will make sure he has the funds, we are all also subject to the downturn in the economy ourselves.”
Consultant cardiologist at the Blackrock Clinic Dr Peter Crean has performed dozens of Tavi procedures over the past two years and says it is “a very good alternative to open-heart surgery to patients in certain risk categories”. He said it seemed “very unfair that full cover is not being offered”.
The procedure costs more than open-heart surgery but when shortened recovery time and reduced complications were factored in, the costs were nearly the same. “Patients don’t realise it is an issue and nor do many referring GPs. It is an awful burden to put on people and it is like a sort of blackmail and so unnecessary,” Dr Crean said.
VHI said it had approved cover for the Tavi procedure in some private hospitals but added that the benefit depended on the plan.
A spokeswoman said it was “an entirely new benefit” and represented “an increase in the benefits provided to customers on the plans in question”. It would be “an exceptionally expensive procedure” so the VHI had introduced a new category of cardiac cover from September 1st, in recognition of the fact that this would be “an additional benefit provided to the customer”.
PICKING A POLICY: NO LONGER AS EASY AS ABC
IT HAS become notoriously difficult for people to keep on top of their health insurance. The VHI has made so many changes to its policies – both in terms of what they are called and what is covered – in recent years that it is easy for people to lose sight of what they are covered for and, crucially, what they are not covered for.
There was a time when the VHI’s plans ran from A to E and it was pretty clear what Plan B, by far the most popular plan, covered. Earlier this year the company renamed all its plans. This, coupled with excesses and add-ons, made it more difficult for consumers to work out what was covered.
In January, for example, the company downgraded the Parents and Kids schemes to which it switched many families in 2009.
When introduced, they offered identical cover to the Plan B policies they replaced. But under the changes, cover for certain orthopaedic and ophthalmic treatments was reduced to 80 per cent of the total cost if performed in a private hospital. This could leave a person facing a shortfall of at least €4,000.
The main port of call for anyone trying to work out what is covered by their scheme is the Health Insurance Authority’s website, hia.ie. It allows people to make comparisons between the major providers and has also been good at flagging changes to policies.
