AIBU to expect NHS staff to ask me for proof that I’m eligible? And to charge me if I’m not?

[workwoes123]

DH, me and two children. We’re all British but have lived in France since 2006. We are fully integrated in the health service here. We have EHIC cards (and the post brexit equivalent) and we always take travel insurance when we come back to the U.K.

The last time we were in the U.K. DS1 had an accident and burnt his hand. We went to the local medical centre (in Scotland). When they asked our address, we gave them my mums address (where we were staying), told them we lived in France and tried to give our EHIC cards etc. They didn’t seem to know to do with them: they just said they’d use my mums address and the last GP we had when we lived here. We weren’t charged anything (didn’t seem like there was any way to do this). We would have been happy to pay: we are totally used to the pay up front / get reimbursed model.

So what do NHS staff think? Are you being encouraged or pushed to confirm eligibility to use the NHS? Would you know how to? Would you question someone who’s obviously British, locally born, has temporary local address?

@Kokosrieksts

I’m not British, had lived and worked here for over 5 years before using maternity services. I got a letter asking to prove I’m eligible. I forgot all about it and had a massive bill sent to me that I then had to dispute by sending proof of address/ payslips/ bank statements etc. So they do check if you are not British.

I had this experience when I returned to the U.K. - am British. I was pregnant and was told I perhaps would be liable to pay for all maternity care. I produced the requested docs but was outraged as I was a citizen, whose dh paid NI the whole time we were out of the country.

I would be wary of the NHS putting a lot of focus on billing foreign patients because that's putting in place infrastructure that could be used to bill all patients as part of privatization.

When I had to go to hospital in another country, payment was the first topic of discussion. It was quite clear that if my (travel) insurance didn't agree to pay, my broken leg wouldn't be treated. I found that aspect of the system there unpleasant.

So while the NHS should pursue payment from those who legally need to pay, I say the NHS should put treatment first. The pursers can see us after the doctors, not before.

@TooTiredForToday

That’s interesting reading, but I think it’s out of date since Brexit: it refers to people from EEA countries having the right to live and work in the U.K. (and this being the basis of their right to access the NHS as a local would)🙄 sadly that’s not the case anymore

Do agree. My near neighbour who only comes to the country a couple of weeks a year as he mostly lives in France, not only voted for Brexit and then chose to become a French citizen... he recently came back to get a complicated and expensive medical procedure on the NHS, and told us how it's brilliant it's all still free for him

He's paying no income tax (and likely not even full council tax), is leaving a big family home empty in an area with major housing pressure as he doesn't like the idea of renting it out and is now a net drain on our medical system. Really annoys me.

I left for Oz in 2011, confirmed by my GP surgery and notes transferred. I came back to the Uk in 2013 and it was like we had a two year holiday. They never said anything or charged us. Tbh, there is a reciprocal agreement 🤷🏼‍♀️

I didn't see anything more recent from a quick look, but I suspect there will be new post-Brexit regulations, which will eventually filter through to a new version of the CEL. It can take some time.

It's an area I used to be involved in a bit at work but not recently, so don't know what the recent regs etc are.

How many of you have had treatment in Europe? We did - diagnosis of an illness - we had to pay but I believe I could have reclaimed it via ehic system but to be honest it all seemed v complicated
The hospital there def had a payments office which maybe we don't have here?

I’d rather than this than what happens in other countries. I heard France is terrible for not treating people without insurance.

@LemonRoses

No NHS staff are not border force. Emergency care is feee for all, thank goodness. Hospitals do recoup costs from overseas residents. Expats chest the system.

Do you mean expats cheat the system? Would that be all expats? Or some particular expats you know or have read about? The OP has explained that she did everything she could to pay

I'm an expat (migrant) too and several years ago had to see my mum's doctor when I was visiting. I tried to get a private GP appointment (which would have been covered by my international private health insurance) but there were none available. I registered with the GP as a temporary patient and filled in a form for them to hopefully claim it back. I think they would have struggled to do this because as I have private insurance I'm not enrolled in the healthcare system of my country of residence (this is perfectly legal, you are allowed to opt out). I offered to pay but they had no means of accepting it. The pharmacist (attached to the surgery) apologised that I'd have to pay two NHS prescription charges! I'd have expected to pay private prescription costs at least. Absolute bargain as far as I was concerned and I could have paid five times as much as I was able to claim them back from my private insurer anyway.

Many, many expats are perfectly happy to pay any charges incurred but it seems the administration involved isn't worth it to the NHS.

Ok reading around a bit more, it appears I ABU to expect to be charged in the U.K. :-)

The EHIC card is (was) meant to guarantee that the bearer would be treated for medical care as a local resident in that country would be. So anyone visiting France (or most other EU countries) and needing medical treatment (at a Gp or hospital) would be treated as a local: pay up front (except for hospital costs which is paid directly), reclaim, get reimbursed.

Conversely anyone visiting the U.K. and being treated “as a local” means they will receive medical care free at the point of delivery, as that’s the system in place.

The problem (if it is one) is that the NHS is pretty much unique in this respect and has no way to / precedent of recouping costs from visitors as it doesn’t directly recoup costs from local residents either. The list I posted above is maybe an attempt to reduce the “free” healthcare provision to non residents - but nhs staff are unwilling / unable to enforce it as there’s little precedent, the systems aren’t in place and it’s not their job.

Apologies to honourable expats. I mean some expats, of course.

@stackemhigh

Not the case. France has systems in place for those on very low incomes, where they can access 100% reimbursement and free mutuelle (top up health insurance) and a lot of other benefits. So they either don't pay or do pay and get fully reimbursed. Same for refugees, sans papiers, there are systems in place to provide care - though of course they are under fire from the right wing politicians. Plus the social security system here is really really generous - so paying a small amount for Dr rdv and medications is within the reach of most. The main things that people have put off have been things that are not well covered by reimbursements - glasses and hearing aids and dental, for example - but that has changed recently as well, with glasses and hearing aids now available for 1€., with all the rest of the cost being met by the govt. The difference here I guess is that people see what the items would have cost rather than just being given them free.

Part of the issue of course is that providing valid ID and establishing your 'regular' status is part of the process in France (and most other EU countries) as part of the 'checking in' process, whether it's routine or medical. It's not the medical staff that do it, it's the secretaries / administrators that sort it all out. The schemes above have to be applied for and that means establishing your identity, your right to resident healthcare, proper proof of address etc.

Its not for clinicians to police this, we are too busy.
This is an admin job but as far as I can see nobody is policing it.

Part of my role in a previous job was supporting the team who collected the monies from foreign nationals. I was told that their rate of collection at this particular trust was about 46% and often they’d just have to give up before they’d even started as the person would have their operation and then they’d realise that they’d given false details and gone home. Not a lot could be done then 🤷‍♀️

As far as I know, treatment is carried out and then the money claimed from the country try of origin.

But your son had a burn, this would be classed as emergency treatment.

I have also been the recipient of emergency care in other European countries without being asked for any ID/insurance/money.

It works both ways and is a decent system.

@socalledfriend

I have also been the recipient of emergency care in other European countries without being asked for any ID/insurance/money.

It works both ways and is a decent system.

It doesn't work that way any more. You'll be expected to have travel insurance, and also very few other systems are completely free at point of access other than the US, so there's usually some payment involved even for locals. I don't think that NHS health tourism is rampant, but it does happen, including by UK citizens who aren't residents, and it shouldn't, given the current state of it.

*other than the US?!! Other than the NHS rather, the US obvs is incredibly expensive!!

Pretty sure I’ve heard somewhere that health tourism costs the NHS £200million a year which is the same cost to run the entire NHS for 15 hours so I’m guessing it’s not seen as cost efficient to chase for money owed? Maybe?

It doesn't work that way any more. You'll be expected to have travel insurance, and also very few other systems are completely free at point of access other than the US, so there's usually some payment involved even for locals. I don't think that NHS health tourism is rampant, but it does happen, including by UK citizens who aren't residents, and it shouldn't, given the current state of it.

This was three years ago in Italy. I got a piece of metal stuck in my eye (long story) so went to A&E. I had travel insurance but wasn't asked for it, for any payment or for any documentation. My Italian is appalling - there is no way they thought I was local

Emergency care is not charged. And regular GP services are often not charged - we took my American MIL to our family GP when she needed antibiotics once and she had all her insurance stuff ready to pay but they said it wasn't needed. She even got the prescription for free as a OAP! She was amazed.

However, it can cause an issue for non-citizens planning on immigrating at a later date if they are found to have used services and not paid. They often have to pay before their cases are processed.

It doesn't work that way any more.
Not that clear cut.
I renewed my UK EHIC this year (UK EHIC, not the new UK GHIC) and it will carry on as before. There have always been some EU countries where you had to pay upfront and claim back.

I believe the UK GHIC works like the UK EHIC, just in fewer countries.

Im a kiwi who's been living in UK for 20 years. i still have a kiwi accent but when I go "home" to NZ the medical staff are very hot on charging me foreigners rates for GP visits etc. Emergency care is free but afterhours GPs, pregnancy scans etc are not if you're not resident.

It's not a massive administrative burden, it's sensible and means that the NZ health system is appropriately subsidised or free for the residents who need it.