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TIA to anyone who can advise:
Very long story short, OH’s elderly aunt, who has many and complex health needs, is visiting from Bermuda, against her doctor’s (and family’s!) advice. She comes every year with no travel insurance and insists that her UK passport alone would entitle her to free NHS care should she need it, despite being told otherwise every year by us.
Well of course she is now in our local hospital with a possible broken shoulder and suspected septicaemia. We are all incredibly frustrated as something like this was always likely to happen one day, given her age and state of health. I’ve looked online but can only find articles saying that foreign nationals are charged at 150% of the NHS rate, but no actual figures.
Does anyone here know how much the charges are likely to be, e.g. for A & E admittance, X-rays and very possibly a few days in hospital with various medications? I assume charges aren’t as astronomical as in the US (and her native Bermuda!) but in a few days we may have to make a decision as to whether she continues to receive care here, one of us flies back to BDA with her on new flights, or a family member comes here to collect her.
*Edit – she has health insurance in BDA but as far as we can make out, that doesn’t cover her for treatment outside BDA and certain US facilities.
If she’s on a ward already ask the staff nurse to put you in charge with the department that deals with this.
You / she may get a visit from them anyway as hospitals are now pretty good at identifying non NHS treatment entitled patients as otherwise they don’t get any money from them!
IIRC from my NHS days the 150% is based on the cost NHS tariff for the course of treatment (i.e. what hospitals get paid by their local commissioner) and depends on complexity of the medical condition as well as length of stay.
The tariff is for a package of care. There won’t be a itemised bill like in the us that charges her for everything done to her down to the last cotton swab or pill.
There doesnt seem to be a reciprocal health agreement with Bermuda
https://www.gov.uk/guidance/uk-reciprocal-healthcare-agreements-with-non-eu-countries
Edit to add – this url looks like it refers to elective treatment
Sorry to hear this.
Listen, my mother was in hospital for 3 months so we got to see lots of people coming and going.
I am fairly certain 50% had no right to NHS free health. A small % even boasted of how they came from Albania/Greece/Croatia specifically for expensive cancer treatment from the NHS (they had family here so may have registered at their address and signed up at the local GP).
At no point did I ever see a nurse/doctor/etc. be interested in the legal status of a patient. If somebody there was going to be eventually charged it is not at the point of treatment. Maybe months from now they will get something, but most certainly will be back home by then.
Unless the hospital is chasing you I believe you won’t have to pay.
Which NHS trust?
My best friend runs the Private Patients Division of a an NHS trust. Her department covers your situation. I will ask her view but it may vary from trust to trust.Sorry to hear this.
Listen, my mother was in hospital for 3 months so we got to see lots of people coming and going.
I am fairly certain 50% had no right to NHS free health. A small % even boasted of how they came from Albania/Greece/Croatia specifically for expensive cancer treatment from the NHS (they had family here so may have registered at their address and signed up at the local GP).
At no point did I ever see a nurse/doctor/etc. be interested in the legal status of a patient. If somebody there was going to be eventually charged it is not at the point of treatment. Maybe months from now they will get something, but most certainly will be back home by then.
Unless the hospital is chasing you I believe you won’t have to pay.
I’m afraid you’re very wrong. The NHS actively pursue fees from those not entitled, drs and nurses are not part of this process. I’m
Sorry to hear this.
Listen, my mother was in hospital for 3 months so we got to see lots of people coming and going.
I am fairly certain 50% had no right to NHS free health. A small % even boasted of how they came from Albania/Greece/Croatia specifically for expensive cancer treatment from the NHS (they had family here so may have registered at their address and signed up at the local GP).
At no point did I ever see a nurse/doctor/etc. be interested in the legal status of a patient. If somebody there was going to be eventually charged it is not at the point of treatment. Maybe months from now they will get something, but most certainly will be back home by then.
Unless the hospital is chasing you I believe you won’t have to pay.
This – the UK isn’t like a lot of countries that won’t even see you unless you put a credit card down. There’s a chance she’ll eventually be chased for the money by the NHS Business Services Authority, but fairly slim chances of the NHS ever recovering it if she doesn’t engage. Private patient sections of NHS hospitals are very different, as that’s planned procedures, so they would be looking to have guarantees in place before you even walk in.
Again, I can tell you categorically that in a trust that I know well, she will absolutely be required to pay. It’s true that many don’t and if they don’t have the funds then there’s not much the nhs can do. Private patients section of this trust are also charged with collecting payments from those not entitled, as a separate matter from planned procedures.
This from someone whose job it is to collect these payments on a daily basis
“When a visitor to the UK it’s charged at the national tariff its + 150% as they say. The tariff is calculated on discharge by nHS coders who apply a HRG code . There’s info online in the NHS England website. When we charge overseas visitors the tariff applied takes into account co morbidities /length of stay different complexities but essentially what a British persons treatment costs (and the integrated care board pays the hospital) +150%.
If they are prove the Aunty is returning to take up residency in the UK ( so things like selling her property in Bermuda/shipping her furniture etc) then she’d be exempt from charges. “First of all, commiserations on what is a very stressful and miserable time.
We have recently dealt with similar – an overseas-resident, UK-passport-holding elderly relative visiting without insurance or common sense, and becoming seriously ill (and in fact then dying) while with us.
In theory the NHS will charge for her treatment. The NHS has a published tariff of charges and they are (broadly speaking and certainly by US ‘headline rate’ standards) not unreasonable.
HOWEVER in practice this varies very much. Where we are – in a quiet and backwards part of the provinces – no-one ever asked, over many weeks of hospital, GP, outpatient, then inpatient and ICU care. Although enormously stressful at the time, we were assured by a hospital consultant friend that it was very unlikely that anything would happen.
Many clinicians within the NHS will “look the other way”, not ask, not co-operate with anything to do with billing. And if she has a UK passport, sounds reasonably British, and has a UK address then it is IMV unlikely that anything billing-related will happen; simply (if it’s not too late) give out a UK address when asked, and no-one will ever worry you about this.
Perhaps in places with lots of overseas visitors, things are more rigorous – I imagine if someone with no English is carted away from LHR by ambulance then wherever they end up might be organised and rigorous about this.
Also consider – if they don’t pay, what is the worst that is likely to happen? OP is probably a traditional “decent person” and not given to such thoughts, but it’s always worth thinking “what can they actually do to me here?” when faced with bills…
Only in the case where they can’t afford to pay, and have UK-based assets (like a pension or house) which are vulnerable to legal attack, is there actually a problem. Relatives are not liable, and the person cannot be prevented from leaving the UK because they have an unpaid debt to the NHS – although if not entitled to enter the UK, entry can be refused for it.
WHATEVER ELSE YOU DO, DO NOT SPEAK TO THE HOSPITAL ABOUT THIS ISSUE UNLESS THEY RAISE IT FIRST.
We, also, spent a lot of time and stress trying to work out how/when/whether we could return said decrepit relative to their overseas residence. Could they fly, would the airline ask questions about their fitness to fly, what help would be needed to get through airport, onto and off aircraft, transport at other end, assistance in their home with washing & feeding, etc. So much to think about, all a waste of time in the end.
I’m also advised that A&E is exempt from charge,
Charges start from admission or outpatient care.Thanks all – we fear the cat is out of the bag anyway, as another (well-meaning) relative registered her with a local GP when she first fell ill.
She is still in A & E so classed as emergency treatment for now – jaw-dropping waiting times in our favour atm!
@Toopoor, sorry to hear about your experience, I am definitely to make sure I have contingency plans in place for our immediate family.
@Annie, it’s East Lancs – I have no idea how pro-active they are at chasing up payment – I hope very! We don’t have an issue with her being billed as she took the decision to travel without insurance and was told many times of the associated risks.What we need is an idea of what the costs will be – does anyone have a link to the list of charges as I can’t find anything on line? Then we can make a decision (together with medical staff) about whether she should stay here and be cared for at her own expense or get her repatriated.
Many clinicians within the NHS will “look the other way”, not ask, not co-operate with anything to do with billing.
It is not the job of clinicians to get involved in billing so there is no looking the other way or not cooperating.
The trust I’m talking about isn’t the one you’re dealing with.
Trying to get a link for you.I get that, but they are still being paid by UK taxpayers so maybe they should be a bit more mindful of who funds all the treatment!
You told this,
NHS England/national tariffs if they want to try and look it up but it’s immensely complicated .
They need to contact the East Lancs overseas visitors team and ask for an estimate. Only they can advise on the potential costs .
I’m thinking it’s trauma and she fell so probably HRG HT52B very major shoulder procedures for trauma complications 2-3 which is about mid point. Up to 9 days in hospital £4412.00 + east lancs Market forces factor which I think is 1.025234 + 150%
So about 7k ish but really they need to ask the OSV team for the deposit. I could be wildly out either way .
Sorry, I’m told this , cut and paste and I’m making it messy.
It is only her best guess so please take advice as she suggests.
Hope that’s helpful and very best of luck.
I take your point about her being warned to have insurance and agree with you but it’s a shame that you now have to deal with all of this but I guess you have to do it.I hope she’s dealt with soon and on the road to recovery, either here or at home.
Many thanks! Quite – our family has to have insurance when we go over there and wouldn’t dream of travelling without it (and to prove the point, when my MIL was there last year she fell over a kerb and broke a rib, they are a really accident-prone family!)
OH is making over to the hospital now to try and get a progress report as the clinicians are dealing with a clutch of assorted elderly aunties who will be in a complete flap and have no idea how to connect to the hospital wifi to get any messages out!
> no idea how to connect to the hospital wifi
This little sentence really conceals a *lot* of hassle.
The hospital walls, at our local, are full of metal and phones only work intermittently if you stand near a window.
The wifi is super-flakey and often does stuff (like silently remove a client from its forwarding table for inactivity, but without terminating the session) which causes iphones to flake out and refuse to reconnect.
Elderly relative is then incommunicado. Nurses are too busy to help with IT problems, the wards never answer the phone, so someone with a job and children to look after is then required to do the 90 minute round-trip, with queuing and parking charges, to make sure relative has been fed and taken to the toilet.
Same here in Worcestershire. My mum was in hospital for 7 weeks last year and I had no phone signal or WiFi at all when I was with her which was most of the time as she was end of life and I needed to be certain that she had the level of care that I wanted for her. Nurses did their best but it wasn’t the level I wanted for my lovely mum.
There was wifi available but it simply didn’t work.
I truly don’t want to turn this into a debate about the merits or failing of the nhs but there’s a lot that could happen to change for the better.NorthernLass, in case it’s helpful there’s a medivac company by Heathrow who I’m told are very good. But that’s going to be super expensive.
For a commercial flight she will need a discharge plan and a fit to fly note before you can plan anything. If she has a GA she may not be able to fly soon anyway.Sorry to hear of your situation. On a generał note OH who is NHS doctor for last 11 years reports that the finance people do swoop down on anyone who can’t prove they are eligible for free NHS cover.
A few years ago I had to declare that I was eligible for free NHS treatment on arrival at a hospital appointment, but I wasn’t asked for proof and that was the one and only time it happened!
As I said, we know there will likely be costs involved, we just want an idea of what these are going to be as this is new to us all.
@Annie, just playing Devil’s Advocate, she is due to fly home early next month from LHR (I had already booked her a CE flight MAN-LHR to spare her the coach journey she was trying to insist on taking) How would the airline know if she was fit/unfit to fly? We can’t rule anything out, she is perfectly capable of discharging herself and turning up at the airport whether or not a doctor says she is fit!
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