Mr. Tony O'Brien:

The way private health insurance works is that most private health insurers have what is known as a direct billing arrangement. A direct billing arrangement, once the forms are signed, enables the HSE or the hospital in question to claim the amount of money that is due in accordance with a predetermined tariff for the treatments provided to the privately insured person in the hospital. Separate to that, there is a scale of fees payable to the consultant, depending on his or her discipline and the nature of the treatment he or she provides, against the tariff that he or she separately claims and is paid directly by the private health insurer. In so far as the consultant has not signed the form enabling the HSE or hospital, as the case may be, to claim the fees due to the executive or hospital, he or she will not yet be in a position to claim the fees due to him or her.