Planned treatment abroad is a foreseeable and strictly defined scope of services that can be carried out abroad, but it requires prior approval from the head of the National Health Fund. In the previous post, we included instructions on how to fill out an application if a patient has to wait a long time for treatment or research in Poland. In this section, we show you how to complete an application if treatment is not available in your country.
As in the case of the so-called waiting condition, the application for treatment abroad is filled out on the basis that the treatment cannot be provided in the country, as described in Art. 42 j. Then, the planned treatment can be performed at any facility in the world – private or operating under the national health care system of a particular country. In order to obtain a positive decision on referral for treatment, it is necessary to confirm the cumulative fulfillment of the three conditions.
Treating a patient abroad – instructions on filling out an application, part 1
Requesting treatment abroad, provided that treatment is not possible in the country
Parts IA and V of the application are completed by the National Health Trust.
Parts IB, II, and VI of the application are completed by the person submitting the application.
The third part of the application is to be completed by a health insurance physician – a specialist in a related field of medicine, holding the academic title of Professor or the academic title of Doctor of Medical Sciences or a qualified Doctor of Medical Sciences.
The fourth part of the application is completed by a Voivodeship Consultant.
The differences appear in Part III, b. III.C. and III.D. the demand
They contain data that enables the placement of treatment abroad and indicates the justification for choosing a particular center. If the patient chooses point 2, the Trust will be obligated to obtain the opinion of the county counselor in Part IV of the application.
Third, b. The place of treatment outside the borders of the country
The country in which the described treatment will be offered must be indicated in the application, in which case you can apply for treatment or research in any country. You must provide the full name and contact details of the foreign healthcare provider (address, phone/fax number, email address). In cases where the required diagnostic treatment or examination is carried out in a large foreign center, in which, for example, there are several hospitals, it is especially important to provide information and contact details for a particular hospital, clinic or department.
Very specific reasons must be indicated in the justification for selection. For example, a center that specializes in treating a specific condition, that performs operations using a surgical technique that is necessary for the patient’s health and not available in the country, or has the necessary medical equipment to be used in a particular case to obtain the appropriate treatment effect.
III.C. Scope of treatment outside the country
When referring to the detailed scope of treatment or diagnostic tests to which the application relates, the full scope of treatment to be offered abroad shall be described as accurately as possible. For example, counseling in order to qualify for treatment, surgery, rehabilitation after surgery and determining the number and frequency of treatment phases – in the case of multi-stage therapy. The scope of treatment should be described using the current International Statistical Classification of Medical Procedures (ICD-9) codes and in words. It is advised to check the aforementioned procedures with the procedures included in the list of guaranteed benefits suitable for a particular scope of treatment:
- Check to determine the required level of detail in the ICD-9 codes (eg in the hospital basket, procedure 39.99 – other vascular procedures not found, but procedure 39.999 vascular procedures – other present)
- Checking to determine if additional eligibility criteria for a particular guaranteed service (such as proton therapy) are met
The justification for the lack of treatment in the country and the need for treatment in a foreign body that provides health services includes the decisive justifications for this type of application, as it relates to the reasons for referring the patient to treatment/research abroad. The reason why it is not possible to provide a guaranteed service to the patient at NCs in this individual case should be accurately indicated. It is equally important to justify the need for the treatment described in the application in the context of the possibility of improving the state of health or saving the patient’s life. For example, why a particular patient needs a surgical technique different from that used in NCs. The information must be confirmed in the medical records that the patient submits for the application, so it is important that the applicant physician reports, for example, the results of the consultations they have had with national reference centers.
III.D. Indications of the transfer to the place of benefits outside the country
This part of the application must be completed if the patient has marked Clause 1.2 in Part IB of the application. Determine the means of transportation to the place of treatment abroad that should be used in the patient’s condition – in the current state of health. One must also remember the actual route of transporting patients (for example, the need to provide bed-to-bed medical air transport from a hospital in Poland to the USA means that an ambulance must also be provided to/from the airport. Not because there is a long distance between the location of the patient and the place of treatment.
Important! After completing the third part, it is necessary to sign the application in the city and the date of signature:
- Not having the signature will result in the application being returned to the patient
- It is the absence of a formal application that prevents it from being processed and the initiation of an administrative case
Fourth part of the application – to be completed by a county advisor to the extent indicated by the head of the fund
If the patient in the application requests that the application be forwarded to the county counselor, After receiving the patient’s request, the fund will request that opinion. The application itself is submitted to the head of the fund without such an opinion, which the fund then obtains as part of the application process.
The opinion of the regional advisor is included in Part IV of the application and must contain the name and surname of the regional advisor, the county in which he is appointed to act as a consultant, the area of medicine mentioned above acting as a consultant, the license number to practice the profession – usually the seals do not have it, and of course must be guaranteed Clarity of all data.
The President of the National Health Trust sends the application, together with a copy of the medical documents within the scope of this application, to the county counselor in two cases:
- duty – If that person requests that the applicant
- my choice – In the event of the legality of obtaining the foregoing opinion, despite the fact that the applicant did not refer to point 2 in Part B
It is a written procedure that is performed individually for a specific patient. A properly prepared opinion should answer all the inquiries in the letter of the head of the National Health Fund. If the county councilor decides to prepare an opinion in Part IV of the application before receiving the letter relating to the preparation of the opinion, for example, because of the urgent nature of the remedy, it is absolutely necessary to prepare such an opinion with reference to all the conditions mentioned in Art. 42 j. This also applies to the need to use a means of transport to the place of treatment, if the subject of the application is also to cover the costs of the aforementioned. Transportation.
If the county counselor is not competent to issue an opinion, he/she submits the request immediately (two business days from the date of receipt of the request) to the county counselor who, in his opinion, is competent in the matter and informs the head of the National Health Trust regarding such transfer. This does not suspend the deadline for issuing an opinion – 10 working days, with the possibility of extending it for 5 days at the request of the consultant.
Important! After the fourth part is completed by the county councilor, it is necessary to sign the opinion indicating the place and date of signing.
The powers of the head of the National Health Fund to obtain opinions on the application
Head of the National Health Fund, according to Article 6 sec. 5 of the Regulations on the Granting of Consent, prior to a decision on the application, may also consult a national consultant in the appropriate field of medicine given the scope of the proposed treatment / diagnostic tests, as well as other persons practicing medicine or medical entities – having professional knowledge in the scope of treatment / tests Suggested diagnostic. The head of the National Health Fund asks for an opinion on the application each time in a letter – in relation to the individual case of a particular patient.
Any properly formulated opinion of a national advisor or other entity asked to express an opinion must:
- Respond to all inquiries received in the letter of the head of the National Health Fund – including, in particular, all buildings listed in Art. 42 J of the law of interest
- In the event that the possibility of carrying out the required therapeutic or diagnostic tests in the territory of the State is found, the national advisor or other entity required to issue an opinion shall indicate the data of the providers who can perform such treatment or diagnostic tests or data confirming the experience of the indicated providers in the treatment or diagnostic tests covered by the application (with indication of its effectiveness)
The opinion must be issued within the deadline, i.e. within 10 working days (with the possibility of extending the deadline, in justified cases, by 5 days at the request of the national advisor or other entity required to issue the opinion.
We also recommend the following:
How to Treat a Patient Abroad with the National Health Trust – A Guide for Doctors and Patients, Part 1
Seeking treatment abroad – the most common mistakes – a guide for doctors and patients, part 2
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