Up to two million private health insurance subscribers face the possibility of having to pay balance or top-up bills to doctors for medical treatment in hospitals from next month following the effective collapse of a long-running scheme which guaranteed comprehensive cover for such fees, writes Martin Wall.
The largest body representing hospital consultants is to pull out of "total cover" schemes with the main insurance companies such as the VHI, Bupa and Vivas after legal advice that such arrangements will be found illegal in a forthcoming Competition Authority ruling.
The current agreement on fees for medical procedures between hospital consultants and the largest insurer, the VHI, expires at the end of next month.
The Irish Hospital Consultants' Association will tell its members and the company this week that it will not be involved in the renegotiation of the scheme.
For the last five years, the Competition Authority has been carrying out an investigation into the "total cover" deals - under which doctors agree to take a higher-than-normal fee for each procedure from the insurance company in return for a commitment not to send any balance or top-up bill to the subscriber.
The consultant association's national council was told last week by its legal advisers that the Competition Authority investigation will find that the agreements were in breach of section 4 of the Competition Act, 2002.
A spokesman for the Competition Authority told The Irish Times last week that its investigation into total cover deals was "ongoing".
On foot of the legal advice, the national council decided that the organisation would not negotiate with the VHI on a new schedule of inpatient and day-case procedures.
Traditionally the representative bodies for consultants have been closely involved in negotiating new schedules although individual members had ultimately to sign a personal agreement with the insurance company.
The schedule of fees agreed between consultants and the VHI - under which the company pays more than €200 million annually to doctors - has traditionally been followed in general by the other insurers in the industry.
For the patient, the development means that there will be no longer a guarantee that their insurance package will provide comprehensive cover for doctors' bills for inpatient or day-case treatment in hospitals.
It is expected that the VHI and the other insurance companies will offer a new schedule of fees to consultants.
However, there will be no involvement of their representative bodies in the process or no endorsement of the fee increases offered. It will be up to each doctor to decide whether or not to accept.
In cases where consultants do not accept the new schedule, it is likely that the patient will face the choice of either paying a balance or top-up fee in addition to the amount paid out by the insurance company or shopping around to find another doctor.
A spokeswoman for the VHI told The Irish Times last night that the company did not know what the Competition Authority would conclude following its investigation into the total cover deal.
The spokeswoman said the issue was one largely between consultants and the authority.
She said that the VHI would hold talks with the consultants' representative bodies on all issues surrounding a new schedule of procedures with the exception of price.
She added that it would be a matter for individual doctors to accept or reject the fee on offer as it had been for many years.