A 74-year-old woman complained to the Ombudsman when the HSE did not refund the full cost of her hip operation.
The woman had waited over two years on the public waiting list for the operation and had decided to travel to Northern Ireland for treatment under the cross border healthcare scheme.
She had paid the full cost of the operation in advance — €12,500, borrowed from a relative — and then sought to reclaim the money from the HSE.
However, the pensioner complained to the Ombudsman when the HSE repaid only €10,900 of the cost involved.
The HSE explained the original approval was based on the information provided by the woman’s consultant.
She had originally been approved for a “non-standard” hip operation.
After the woman’s surgery, the Northern Ireland consultant had not confirmed that she had received the more expensive “non-standard” surgery.
The HSE made a payment for a less expensive “standard” hip replacement, but committed to having the woman’s medical chart assessed to check whether the more complicated procedure had been provided.
When the woman contacted the HSE the independent assessment had not been carried out.
The HSE accepted that the assessment should have been carried out sooner. As a gesture of goodwill the HSE apologised to the woman and refunded her the shortfall amounting to €1,600.
In another case, a man who had HSE approval for in-patient treatment (involving an overnight stay) for carpal tunnel syndrome in his hands paid a Nort-hern Ireland hospital in advance at a cost of nearly €7,000.
However he was deemed well enough to leave hospital on the same day, making him a day patient and entitled to a refund.
However, the hospital said the cost was the same whether he went home or remained overnight.
The HSE could only reimburse the man as a day patient which amounted to just over €2,000. This left him with a shortfall of almost €5,000. When the Ombudsman checked with the hospital, it accepted that an error had been made and agreed to refund the man’s outstanding costs.
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