Private A&E departments: what’s the deal?

Unless you have deep pockets and expensive health insurance, you may be best to stay away

With the overcrowding crisis in public hospitals showing little signs of dissipating – recent figures put the number of patients on trollies at still more than 500 – an option that may be worth considering is attending a private emergency department in lieu of visiting your local public hospital.

It seems that many people are already doing just that.

Beacon Hospital in south Dublin for example, has seen numbers attending its emergency department rocket by up to 40 per cent over the last two months as the pressure on public hospitals has intensified, according to deputy chief executive Brian Fitzgerald.

But how do they work, what ailments are they appropriate for, and just how much can you expect to pay to be seen?


What complaints are suitable for a private A&E?

While emergency departments of private hospitals treat a wide range of illnesses, injuries and complaints, ranging from respiratory and cardiac complaints to surgical emergencies and broken bones and sprains, not all patients will be seen.

Typically, these include pregnant women, someone suffering a major trauma, such as from a car accident, or a person with psychiatric issues.

VHI SwiftCare clinics are another option, although the range of complaints that can be treated tends to be more limited, and they focus mostly on fractures, cuts that need stitching and minor illnesses.

How restrictive are the opening hours?

Another factor that may preclude you from being able to attend a private A&E is the opening hours. While these have improved substantially since these departments first opened, most will still be closed by 6pm each day, while others do not open on Sundays or bank holidays.

However, given the jump in demand, Fitzgerald says that the Beacon is considering extending its opening hours to a Sunday. VHI’s SwiftCare clinics operate the longest hours, opening from 8am-10pm each day.

How quick is it?

A major attraction of opting for a private emergency department is the speed with which you might be seen. Waiting times in the double digits are not unheard of in public hospitals; most private hospitals promise that you will be seen by a consultant within an hour.

Patients at the Beacon for example, will be seen by a consultant within an hour “95 per cent” of the time, Fitzgerald says.

And of course the process of getting a bed if you need to be admitted should be much more straightforward.

Fitzgerald says it is "rare" that a patient who needs a bed would not get one that day, while a Blackrock Clinic spokesman says there would be beds available "most of the time".

VHI aims to treat patients within an hour, and it now gives waiting times for its clinics on its website. On a recent Friday morning for example, patients could expect to wait for just five minutes at its Dundrum clinic in south Dublin, or just three minutes in Swords.

Can my children attend?

Most private hospitals will only treat teenagers. Blackrock Clinic, for example, will only treat children over the age of 14, while at the Mater the age minimum is 16. Children between the ages of five and 16 can be treated for minor injuries only at the Galway Clinic, while VHI SwiftCare clinics will treat babies from 12 months and up.

How much does it cost?

In short, unless you have fairly deep pockets – or up to €500 you can spare – and an expensive health insurance policy, you may be best to stay away from private emergency departments. Attending such a department in a private hospital will mean that you’ll be treated by a consultant – but it also means that you’ll be paying consultant-type fees.

Typical fees start at about €150 to be seen by an consultant but if tests and further diagnostics are recommended, the bill will start to ratchet up.

For example, blood tests at Blackrock Clinic cost up to €300, depending on the complexity, while an X-ray at the Beacon Hospital will cost you €120.

There is some certainty in how much you will be charged however, in that most private emergency departments operate a cap policy, which ensures that your bill won’t exceed a certain limit, typically about €500, regardless of the tests you need to get done.

While there has been an element of confusion about this cap, and whether or not €500 needs to be paid in full upon presentation – Blackrock Clinic says patients need to pay only €140 upfront and any additional fees upon discharge.

However, your total bill may actually exceed this cap if you need to be seen by another consultant, such as a cardiac specialist for example. At the Mater for example, a separate consultation charge of €150 will apply and this will not be included in the €500 cap.

If you are admitted to a private hospital after attending an A&E and you have adequate insurance cover, the cost of all the tests and procenures will be covered by your insurance policy.

Another option is a VHI SwiftCare clinic, which charges €125 per visit and offers a reduced fee of €65 if you have been referred by a GP. Private hospitals don’t typically offer a reduction for GP referrals, unlike public emergency departments.

There is also a discount for VHI members at SwiftCare clinics.

Indeed, most VHI members will pay a reduced fee of just €50 upfront to attend such a clinic.

What can I claim back with insurance policy?

You may be entitled to a reimbursement of some of the private emergency department charges depending on the terms of your insurance policy.

Similarly, the cost of additional tests and X-rays can be submitted as an outpatient expense, while MRIs/CAT scans etc, may be covered in full depending on the terms of your policy. Remember however, if you have an excess on your plan and you haven’t met it, you may not be able to claim anything back.

This means that where possible, you should check out your entitlements before you visit.

With GloHealth for example, you are only entitled to some money back on the registration fee if you have the Sports Cover Personalised Package or Travel & Sports Cover Package, and you will only be able to claim back €30.

At Aviva, some of its level 3-5 plans provide cover towards the cost of private A&E, and it’s not subject to excess.

For example, the Optimise Gold plan offers a €100 contribution towards the examination fee, while Optimise Platinum will pay you back €150.

With Laya Health, members of its Flex 500 Choice plan (€810 a year) for example, can get €60 per visit back on a visit to a private A&E.

Remember, you can also claim tax relief on all medical expenses that are not reimbursed by an insurer via your Med 1 form at a rate of 20 per cent.

Do I need insurance to be admitted to a private hospital?

One challenge that might arise is if you visit a private emergency department without adequate insurance cover but need to be admitted. As such, it can be worthwhile, again where possible, to check the terms and conditions of your policy before attending – cover for so-called “high tech” hospitals is generally limited to the more expensive policies.

Laya Health says that for patients admitted to a private A&E, more than 90 per cent of its schemes offer some level of cover for private hospitals. With Aviva, its Level 2 and above plans typically provide a level of cover towards private hospital care. For example, the popular Aviva Select Plus Plan, which costs €854, has cover for a private room in selected private hospitals at the Beacon Hospital subject to €150 excess per claim. The insurer’s top Level 5 plan, Optimise Platinum, which has an annual cost of €5,687, has full cover for a private room in a private or high-tech hospital.

If you don’t have insurance, you can opt to be admitted on a “self-pay” basis. At the Beacon for example, typical room charges start at €800 a night, and the hospital is planning a significant self-pay campaign. Fitzgerald estimates about 10 per cent of its patients now either pay for themselves, or cover the excess on a health insurance policy.

“We’ve had a lot more inquiries from people who want to self-pay,” he says.

But, if paying for yourself isn’t an option, you’ll have to go back to a public hospital and start the process again. And, while you may have gotten tests done in the private hospital, it’s often the case that a new doctor will want to get their own tests done, so you may have to go through those all again.

Can I call a private ambulance?

Some of the private hospitals accept private ambulances. Blackrock Clinic works with Medicall Ambulance Service and you can expect to pay about €180 for a private ambulance if you live within the M50 area.

Arranging such a service can be done via the ED or Medicall, but a spokeswoman for the clinic points out the service is not for acutely ill patients, because there can be a time lag.

If for example, you fear someone close to you is having a heart attack, the best option is to call 999 for a public ambulance, she says, as this should arrive much faster. On the other hand, if someone has had a fall or is less mobile and the condition is not acute, a private ambulance can be a suitable option for travelling to a private ED.