Hospitals due €200m from health insurers

PUBLIC hospitals are owed almost €200 million in unpaid private patient charges, inpatient levies and other costs over the past year as a direct result of insurance coverage delays.

An unpublished HSE value for money report has detailed a series of financial gaps at the facilities over the past 12 months.

The document was drawn up by health service officials to examine a range of payment concerns surrounding private insurance claims, private patient charges and inpatient levies. These costs are directly linked to when insurance firms agree they are responsible for covering medical costs accrued by certain patients’ treatment.

The unpublished report, completed earlier this year, and a second follow-up document drawn up in March, found:

* Public hospitals were owed €191.3m in unpaid private patient costs between March 2010 and March 2011 — almost half of the €438.8m expense accrued.

* Galway University Hospital/Merlin Park (€16m out of €23.6m still owed), Tallaght (€16.4m out of €33.3m) were the two worst affected facilities.

* They were followed by the Mid-Western Regional Hospital in Limerick (€15.6m out of €31m) and Cork University Hospital (€14.8m out of €35.9m).

* None of Ireland’s 29 statutory acute hospitals and 17 voluntary hospitals received the full payments owed during this period.

* Statutory hospitals — including CUH, Mallow, Kerry General and South Tipperary — were still owed more than half of the fees at the time of the reports.

The document — obtained by trade newspaper Irish Medical Times — also found consultants in the HSE West area have been worst hit by the insurance payment situation.

According to the report, the 10 highest value claims in relation to consultants per region amount to €4.5m in the HSE West, €2.8m in the HSE South, €2.7m in HSE Dublin Mid-Leinster and €1.8m in HSE Dublin North East.

The highest costs owed as a result of individual consultant action relate to a doctor in Mercy University Hospital in Cork city (€774,620) and two doctors in Limerick Regional (€705,367 and €617,367 respectively). This money is owed by insurance firms to the HSE as a result of medical treatments carried out on private patients by the consultants.

The report noted while progress on the issue has been made, problems are inevitable as the charges system is “overly complex”.

“The process for submitting claims for private charges remains overly complex in that it requires the hospital to collate the entire claim before submitting the hospital’s own bill for the accommodation charge.

“This is inefficient for hospitals as most could issue accommodation bills within a short period of days after discharge,” the document concluded.

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