VHI will not pay for consultants not on specialist register

HSE indicates hospitals could pursue patients if bill not settled by insurance firm

VHI subscribers planning to see consultants in public hospitals should check the doctor they intend to visit is on a specialist register. Photograph:  Alan Betson

VHI subscribers planning to see consultants in public hospitals should check the doctor they intend to visit is on a specialist register. Photograph: Alan Betson

 

VHI subscribers planning to see consultants in public hospitals should check that the doctor they intend to visit is on a specialist register in order to avoid a potential medical bill.

The State’s largest health insurer has said it will not pay public hospitals for visits by its subscribers to consultants who do not have specialist qualifications in the area in which they are practising.

The HSE yesterday said hospitals could, in some circumstances, pursue patients directly over their bill if the account was not settled by the insurance company.

The Irish Hospital Consultants’ Association (IHCA) last weekend said public hospitals were increasingly appointing doctors without specialist training, skills or expertise to serve as temporary consultants in some areas due to staffing difficulties.

VHI said it had a “robust procedure” for registering consultants for the purpose of assessing their claims. “It is a prerequisite for registration that the doctor’s name and details appear on the appropriate division of the specialist register maintained by the Medical Council. ”

The insurer said if a consultant was not on the specialist register maintained by the Medical Council “then he/she is not registered with VHI Insurance and we will not pay either the hospital accommodation charges or the associated professional fees”.

“We are however obliged to pay the statutory €80 per day levy,” it said.

Compromising safety

The IHCA said the appointment by hospitals of doctors who were not on the specialist register to fill temporary consultant posts was compromising patient care and safety.

Its president, Dr Tom Ryan, said public hospitals were filling an increasing number of temporary consultant posts with doctors not on the register as a means of circumventing growing problems of recruiting and retaining consultant staff. He said these problems were being caused by uncompetitive pay rates and working conditions.

This practice violated “the most basic professional standards within the public health services” and was in breach of the 2007 Medical Practitioners Act, he said.

The HSE has argued that doctors who are not on the specialist register are only appointed to serve as temporary consultants in emergency situations. However, it declined to say how many doctors not on the specialist register are currently in temporary consultant positions.

The HSE said its policy in respect of consultant appointments, both permanent and temporary, was that it was a requirement that they were on the specialist register.

Emergency circumstances

“There are limited circumstances where, in order to ensure senior medical coverage, an experienced registrar not on the specialist register may cover for an absent consultant to ensure the provision of safe quality care. This will only occur as a final option in emergency circumstances.”

The IHCA maintained that some consultants who were not on the register had been serving as temporary consultants “for years”.

Asked what would happen in the event of an insurance company declining to pay public hospitals in respect of subscribers treated by a consultant who was not on the specialist register, the HSE said: “If patients with private health insurance indicate to hospitals of their wish to be treated as a private patient, all relevant charges will be directed to the insurance company for payment.

“In the event a patient has private health insurance, but chooses to be treated as a public patient, then the patient must decide whether their insurance company or the patient themselves will pay the public hospital charges.”

It added: “In the event hospital charges remain unpaid by insurance companies hospitals may notify patients of the payment delay.”