The VHI's ongoing refusal to pay fees to certain consultants who have provided treatment to privately insured patients has been labelled as bizarre and outdated by the Irish Hospitals Consultants' Association (IHCA).
The VHI is unwilling to pay some locum consultants working on short-term contracts of more than three months because, it says, their jobs have not been formally approved by Comhairle, the body which advises the HSE on consultant staffing.
The stance could mean that patients admitted to hospitals in emergency situations and treated by locums subsequently could be faced with paying consultants' fees despite having fully paid-up insurance policies.
The locum consultants for whom the VHI does not offer cover are fully qualified and on the specialists register. They are employed directly by the hospitals and work with public patients, so are effectively approved by the HSE, the body into which Comhairle was subsumed as part of the Health Act 2004.
Donal Duffy of the IHCA said the VHI policy is "long past its sell-by date" and describe it as "bizarre". The IHCA doesn't deal directly with the insurance companies over fees, to avoid charges of price fixing from the Competition Authority, but it does advise affected locum consultants.
"The numbers wouldn't be huge," according to Duffy but it is still an "ongoing problem for a number of consultants", he says.
The VHI defended its stance and told The Irish Times that it had adopted its position because of "potential legal implications" of what it describes as "unregulated consultant appointments".
"In the case of non-permanent consultant appointments of duration greater than three months, the post must be approved by the NHO/Comhairle due to the potential legal implications of unregulated consultant appointments," the insurer says.
It said its priority is to ensure that its members receive the best possible standard of care at all times and "therefore we adopt the standards of the body who look after the recognition of public hospital appointments to ensure this is delivered".
The IHCA pointed out that locum consultants are just as qualified as those in permanent positions and are able to offer the same standard of care. "As far as we are concerned, if a consultant is qualified to work with public patients then they are equally qualified to work with private patients," Duffy said.
The VHI is the dominant player in the Irish private health insurance market, with an 80 per cent market share. Both BUPA and Vivas do pay the locum consultants. The company declined to comment on the position adopted by its competitors.
One locum contacted by The Irish Times said the policy could lengthen the waiting lists of fulltime consultants. In circumstances where locum consultants are operating alongside full-time consultants, VHI patients have little option but to attend the former, even if a locum is more readily available.
And he warned that, theoretically at least, patients with health insurance admitted to hospitals in emergency circumstances may be liable for the cost of private consultant care because of the VHI policy.
Such patients account for 70 per cent of hospital admissions. If a locum is on duty when a patient is admitted then all treatment and medical care is provided. But while in the case of privately insured patients the hospital can subsequently bill the VHI for its fees, the consultant cannot because of the insurer's policy. As a result VHI policy holders could be billed by consultants after the insurer refuses to pay out.
The HSE said the VHI rules regarding payments to consultants whether permanent, temporary or locum, were drawn up without reference to it "or any of its predecessor bodies". In a statement the HSE said the onus was on individual consultants "to ensure that they meet the criteria specified by individual insurance bodies regarding being eligible for payment for private services rendered".
