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Vhi claims it ‘owns’ procedure codes and threatened legal action

Vhi has claimed copyright over the schedule of benefits, including codes and descriptions of medical procedures, used by other health insurers in the market, a rival company has informed the Department of Health.

In correspondence to the Minister for Health Simon Harris on 15 February, seen by the Medical Independent through Freedom of Information law, the Managing Director of Irish Life Health Mr Jim Dowdall said it was a “serious matter” that would “drive up costs within the market”.

“The State insurer, Vhi, is now claiming copyright over the schedule of benefits used by all other insurers in the market. This is despite the fact that these schedules have been in use by all other health insurers since competition commenced…

“This schedule of benefits provides codes and a detailed description of medical procedures carried out by medical consultants. As you may be aware the majority of procedure codes included in the schedule of benefits come from the minimum benefit regulations.”

It had been “market practice” for all insurers to use similar coding numbers and clinical indications for consistency of administration, he outlined.

Vhi alleged this was breach of “its copyright” and threatened to commence litigation in the High Court, he added.

According to Mr Dowdall, insurers in the UK agreed to formulate one standard set of codes and it was possible to obtain a licence for a “comprehensive set of clinical codes and clinical indicators from the Clinical Coding and Scheduling Development Group (CCSD) in the United Kingdom for approximately £6,ooo”.

If Vhi persists in its claims, it is likely competitors would be forced to implement an alternative coding system such as that provided by the CCSD, Mr Dowdall stated.

The consequences would include “consumer confusion” and higher consultant and hospital costs due to an increased administrative burden. 

On 6 March, Minister Harris’s private secretary Ms Paula Smeaton responded that the Department’s preference was for “no fragmentation in the schedule of benefits”, but the matter needed to be resolved by the companies.

An Irish Life Health spokesperson declined to comment.

A Vhi spokesperson said: “The creation, maintenance, production and updating of its schedule of benefits is very costly for Vhi. This work represents thousands of hours of highly specialised work and underpins Vhi’s health insurance business. Vhi reserves the right to take the necessary measures to restrict the use of its schedule of benefits without appropriate recompense.”

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