Health Insurance
All of the doctors here at Dublin Gastroenterology and Endoscopy Group are participating providers with all of the major health insurers (VHI, LAYA, Irish Life, Garda, ESB)
Health insurance is a complicated business these days - there are over 450 health plans available on the Irish market today.
If you are coming for a procedure, there are a number of important things to check with your insurer:
1. Coverage at the Mater Private Hospital
- will your policy cover you for a day case procedure at the Mater Private? Most policies will fully cover the charges associated with the procedure, though some plans carry an excess (paid out of pocket by the patient), and some basic policies do not cover the Mater Private at all. If this is the case, you have the option to self pay, or can return to your GP for a referral elsewhere.
2. Coverage for the specific procedure.
- every procedure is assigned a procedure code, which your insurer may look for when trying to answer this question for you.
The indicator code for GASTROSCOPY (OGD) is 194
The indicator code for a COLONOSCOPY is 455
The indicator code for a LEFT COLONOSCOPY is 450
3. Coverage based on indication (reason for the procedure)
- most health insurers have a very specific set of criteria, known as indicator codes, for which they will cover a procedure, Your doctor will have provided most of that information on the referral form. However, we may occasionally need to clarify this with you, and will always advise to you check with your insurance company ahead of the procedure.
For example, a person may complain of blood in the stool, which meets the criteria for coverage for a colonoscopy with all insurers. However, if a person had a colonoscopy 2 years previously for blood in the stool (the same 'indication'), that procedure may not be covered, and further information may need to be sent to the insurer before booking the procedure.
Another example is a person who has no symptoms, but would like to have a 'check'. Most insurers do not cover a procedure without relevant symptoms or a specific family history.
A third example is a person who may have obtained health insurance recently, but has had a chronic condition such as inflammatory bowel disease, or undiagnosed symptoms for many years, which pre-date enrolment in health insurance. The insurer may have a waiting period for 'pre existing conditions, during which time procedures related to that condition may not be covered.
As each patient is likely to be unique in their circumstances, the simplest thing for you to do is call your insurer for clarification that you are covered for the HOSPITAL, the PROCEDURE, and the INDICATION. We will assist you with this as much as possible, but the insurers will only deal with the policy holder.
Below is a list of useful web links and phone numbers for the major insurers in Ireland. They will look for your policy number before giving you any specific information, so be sure to have this to hand: