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Other Health Insurers expected to agree terms shortly

Minister for Health Leo Varadkar has welcomed news that the HSE and VHI have agreed terms to speed up the processing of claims and payments for insured patients in public hospitals. Under the terms of the agreement, an accelerated payment of €100 million will be paid by VHI before the end of the year.

Discussions are continuing between the HSE and other health insurance market participants and it is hoped that these can also conclude positively and with agreement.

Minister Varadkar said: “I very much welcome the first of these arrangements concluded between the HSE and VHI. There will always be a lag time between insurance claims made and paid. This is true for all forms of insurance. However, the level of outstanding charges relating to unsubmitted claims has been an ongoing issue for the Department and the HSE. This new arrangement, which we hope to finalise very soon with the main operators, will ensure that insured patient charges are submitted and received by public hospitals in a timely manner in the future.”

The agreement commits all parties to introduce electronic claims processing. This will benefit patients, providers and payors by ensuring that claims are submitted, processed and communicated in a timely manner.

This agreement follows discussions with the Insurance Ireland Health Insurance Council, which includes the State’s four main health insurers, and the Minister for Health last year around the management of claims costs. The lack of certainty around public hospital charging was cited as a key driver of costs for all insurers. This agreement is expected to be finalised in January 2016 and will provide greater certainty for insurers of their liability in respect of these charges.

Prior to today’s agreement the collection of patient charges was generally slow and complicated due to a lack of a formal payment procedure between the HSE and the insurers and the difficulties experienced by the HSE around the collation and submission of their claims to insurers for processing. This led to a build-up of claims not submitted for payment, which in turn contributed to outstanding uncollected level of private patient income of €314 million at March 2015 from all insurers.

The new arrangement does not affect the rates of private in-patient charges, which the Government has kept frozen at the level set in 2013 and will have no impact on health insurance premiums. Equally, it does not change a patient’s rights to query hospital and Consultant charges on receipt of their Claims Statement from their insurer.