HSE and Voluntary Hospitals Write Off Millions in Unpaid Health Insurance Bills
The HSE and several voluntary hospitals have written off millions in unpaid health insurance bills, causing concern among politicians. Issues include administrative delays, incorrect insurance cover, and disputes over treatment necessity. Efforts are underway to appeal rejected claims and recover funds, but hospitals face significant financial strain from these uncollected revenues.
The Comptroller and Auditor General reported that the HSE wrote off over €4 million in unpaid health insurance bills in 2024. Voluntary hospitals, publicly funded but independently run, also informed the Dáil Public Accounts Committee (PAC) that they face millions in unpaid insurer bills. Politicians on the PAC expressed concern over these write-offs, especially as hospitals face financial strain, noting many bills go unpaid due to administrative delays like unsigned forms.
Several voluntary hospitals detailed their financial disputes with insurers to the PAC. The Mater Hospital reported €1.2 million in unpaid invoices for 2025 and €1.4 million for the previous year. St Vincent’s University Hospital in south Dublin wrote off €612,000 last year, with total private health insurer revenue of €4.68 million in 2025. Tallaght Hospital had €8.4 million in uncollected revenue at the end of last year, down from €18.2 million in late 2021.
Hospitals cite various reasons for non-payment, including patients not signing private inpatient forms or claims not being submitted on time. While hospitals have an agreement with VHI, the largest insurer, they lack similar arrangements with others. The Mater Hospital noted that VHI’s agreement ensures 70% payment if basic patient criteria are met, but hospitals have limited recourse when other private insurers reject claims.
To address this, the HSE awarded a contract to a company to review rejected claims and appeal where recovery is possible, leading to successful appeals. Insurers often decline payments due to incorrect insurance cover (e.g., multi-occupancy vs. single-occupancy rooms), beds not being on a bed map, or deeming treatment unnecessary. Invalid patient signatures on forms or refusal to cover the full duration of a patient’s stay also lead to unpaid bills. St Vincent’s previously allowed a grace period for signing forms, but a 2016 challenge by an insurer and inconclusive 2022 court findings led the hospital to continue billing but provision for bad debt related to the grace period, which was written off in 2025.