‘As a long-term VHI customer I was very upset’: Why all insurers, except one, cover an eye surgery unit

A Cork-based reader has been enraged by VHI after she and her husband paid handsomely for cover for decades only to discover that a procedure he had done recently was not covered as a result of what amounts to a geographical quirk.

As many readers will know, health insurance is not cheap and it is only getting dearer with the three providers rolling out multiple price hikes over the last year but Geraldine might have been able to stomach the increases from the VHI had it been there for her husband at his time of need.

It wasn’t and, she says, the company let her down in a most infuriating fashion.

“Last Friday my husband attended the Institute of Eye Surgery, which has opened a unit at the Affidea in the Elysian in Cork,” she writes.

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“After having several eye tests and scans, which we paid €300 for, he was diagnosed with a number of issues. But, by far the most concerning is what is termed Wet Macular Degeneration in one eye.”

He was told by his consultant that he needed an injection in is eye as a matter of urgency,

“The cost is €275 and there will be others,” Geraldine writes. “I rang the VHI to ensure we had coverage. Imagine my surprise to hear, while all other Institutes of Eye Surgery are covered by the VHI, the Cork unit is not.

“The unit opened around four months ago and we were referred there by our optician.”

Geraldine notes that all the other private health providers offer cover but not VHI.

“As a very long-term customer of VHI I was very upset. The eye institute offered us a slot in Waterford for the injection, as they have coverage [but] the idea of having to drive to Waterford to seek a service that is provided by the same clinic as in Cork is madness,” she says.

It certainly sounds odd.

We contacted the VHI to find out what was going on.

A spokeswoman said that it had “recently received an application for inclusion in VHI’s directory of services from the Institute of Eye Surgery in Cork which is temporarily based at the Affidea facility in Cork”.

That application is currently being assessed “to ensure that we are getting best value for our members as we meet their healthcare needs”, the spokeswoman said.

“There are a number of factors and criteria we need to consider before adding a facility to our directory of services, including clinical eligibility and member need.

“VHI also needs to consider the overall cost of adding additional facilities to the directory and the likely impact that may have on members’ premium. We hope to conclude our assessment in the coming weeks.”

The spokeswoman said that there “are very significant costs associated with these eye services and VHI needs to ensure that the additional services will be cost effective. Currently VHI pays up to €20 million annually in the management of macular degenerative disease”.

We are not sure how much that does for our reader but as the treatment is likely to be ongoing we can but hope that the cover she needs – and is paying for – will soon be in place.

If you have a query or a complaint about a company or service or feel you have been let down or mistreated and would like us to look into it please mail pricewatch@irishtimes.com