10 health care services that you need to have a free but require money
Health / / December 19, 2019
What medicare put CHI
As part of the MMI system are basic and territorial programs of state guarantees of rendering free medical care to citizens. BasicOn the program of state guarantees of rendering free medical care to citizens for 2018 and the planning period of 2019 and 2020 It provides that citizens should have free:
- primary care, which comprises prevention, Diagnostics, treatment of diseases, pregnancy;
- specialized, including high-tech assistance - similar to the previous item actions that require special techniques and sophisticated medical technologies;
- first aid;
- palliative care - pain relief and disease manifestations terminally ill patients.
The document also lists a list of diseases and conditions for which medical care should be provided free of charge. In 2018 it:
- infectious and parasitic diseases;
- diseases of the endocrine system;
- nutritional and metabolic diseases;
- nervous system diseases;
- diseases of the blood forming organs;
- certain disorders involving the immune mechanism;
- disease eyes and adnexa;
- diseases of the ear and mastoid;
- diseases of the circulatory system;
- respiratory diseases;
- digestive diseases including diseases of the oral cavity, salivary glands and jaws (except denture);
- diseases of the genitourinary system;
- Skin and subcutaneous tissue;
- diseases of the musculoskeletal and connective tissue disorders;
- injury, poisoning and certain other consequences of external causes;
- congenital anomalies (birth defects);
- deformation and chromosomal abnormalities;
- pregnancy, childbirth, the postpartum period and abortions;
- Certain conditions originating in the perinatal period, children;
- mental disorders and conduct disorder.
The list also included the symptoms, signs and deviations from the norm, not referenced to the diseases and conditions. Accordingly, the medical care for any of these ailments, you should be getting for free.
In each subject of the Russian Federation regional authorities develop and approve territorial programs of state guarantees of rendering free medical care to citizens. You can find it, as a rule, on the site of the local health ministry or department with a different name but similar functions, as well as on the website of the Territorial CHI funds. Regional programs can expand the range of services provided under the policy, but not to cut it.
What prepositions are used in hospitals you to pay for the service
"This is not part of the standard, there is no tariff for the service"
For many diseases are approved by the Health Ministry standards that dictate what, when and how often to do the patient. Even if the diagnosis and treatment requires something that is not present in the standard, assistance provided by the program of state guarantees. In it, by the way, it does not say anything that you can leave the patient writhing in pain on the doorway of the clinic, if the aid is not fare.
"This is not a destination, but a recommendation"
The fact that the doctor has prescribed, outside the scope of the MLA and is paid from the fund, because it is acting in accordance with the standards. At the same time a recommendation like as not obligatory to perform, and so you can have a corresponding service only for the money.
But it is important to distinguish one from the other. For example, in osteochondrosis doctor may recommend preventive exercises between exacerbations, to alleviate the condition. A x-ray - a designation required for diagnostic picture and recommendation it can not be.
"The institution is no MRI machine, ultrasonic"
You must send in the institutions working in the CHI system in which the equipment is. These studies are necessary for the production of certain diagnoses. The absence of the device is not to say that the doctor has to read the tea leaves, if the patient can not get the service for the money.
What services are available for free, even if you are asked to pay
1. Analyzes of thyroid hormones
If you are ever faced with the necessity of the study of thyroid hormones, it is possible that heard from the doctor that "simple" tests done in the clinic, and for "difficult" in the establishment no equipment. However, the reasons may be different, the result is - in accordance with medical standardsRussian Health Ministry Order dated November 9, 2012 N 735n "On approval of the standard of primary health care in primary hypothyroidism", Under the policy you need to do the following studies:
- level of free triiodothyronine (T3);
- level of free thyroxine (T4);
- antibodies to thyroglobulin;
- antibodies to thyroid peroxidase;
- antibodies to receptor thyroid stimulating hormone (TSH).
If a nontoxic goiter in the list are addedRussian Health Ministry Order dated November 9, 2012 N 692n "On approval of the standard of primary health care at a non-toxic goiter" additional tests are needed for diagnosis.
2. Help for obesity
Overweight people decided to send to the gym and dieticians that require significant amounts of money. In this case, obesity - a disease that is treated by the MLARussian Health Ministry Order dated November 9, 2012 N 752n "On approval of the standard of primary health care for obesity".
The physician should determine the reasons for the excess weight (Overeating, taking the medicine, and so on). The standard includes the reception at the gynecologist, urologist, cardiologist, endocrinologist, psychiatrist, and even a nutritionist, a variety of studies.
In addition, according to the standard, you must calculate daily caloric taking into account body weight and physical activity. Probably a doctor with specialized education it will turn out better than the self-proclaimed nutritionist from Instagram.
3. In vitro fertilization
Since 2013, expensive IVF procedure is included in the MLA ProgramOn the procedure for the use of assisted reproductive technologies, contraindications and limitations to their use (as amended on February 1, 2018). However, to participate in it, a policy is not enough.
Patients who have shown in vitro fertilization, selects a special commission on the basis of test results and research. Which, incidentally, are also made under the policy.
In this case, the MLA program does not foresee the use of donor eggs or embryos and surrogacy. But 2018 may be free to implement cryopreservation of embryos produced within the IVF procedure.
4. Provision of medicines in the hospital
This also applies to the clock and day of stay in hospital: agency should provide you with a fully necessary medicines.
5. Consulting a specialist
You do not refuse to the reception, but they say that it will have to wait a month or even more, as a specialist is busy. But "over the counter", he is ready to examine you today. There is a logical question: if it is busy, he finds time to pay the patient?
The Program of state guarantees of free medical care to citizens prescribed waiting periods:
- Admission therapist - no more than 24 hours of treatment in medical institutions;
- consultation of a specialist - no more than 14 calendar days;
- diagnostic and laboratory tests - no more than 14 calendar days.
6. dental services
The exact list of services provided on the site is better to clarify the CHI territorial funds in the general collective agreement for the current year. At a minimum, you can free of charge:
- receive anesthesia (except orthopedic operations);
- cure tooth decay;
- remove dental plaque;
- learn oral hygiene by expert guidance.
A list of free services is long enough, and more extensive than you might think when it comes to free dentistry. You may be offered an additional service for the money, but not blackmail drilling a tooth without anesthesia, if you do not pay.
7. MRI, CT and ultrasound
You should inspect for free, but only on prescription. The doctor will refer you to the procedure, if it considers it important for diagnosis and treatment. But maintain your hypochondria and to satisfy the desire to be examined from head to heels under the policy are not required, it needs specific complaints.
If massage services are needed for the treatment, you must provide them free of charge. But we need a doctor's appointment.
A vaccine against infections made to the national calendar vaccinationsYou can also get free. In it appearFederal law from 17.09.1998 N 157-FZ (ed. from 07.03.2018) "About immunoprophylaxis of communicable diseases" :
- Hepatitis B;
- whooping cough;
- Haemophilus influenzae;
- pneumococcal disease;
The site has the Ministry of Health StandardOn approval of the standard of primary care for depression primary health care at depression. According to the document, in the diagnostic phase, for example, you can be examined by a psychotherapist, psychiatrist, psychologist.
How do you know whether you are entitled to service
The easiest way - to call the insurance company and ask. Her number is right before your policy. But if you are accustomed to trust no one, the following algorithm.
1. Check whether the purported or detection of the disease in the baseOn the program of state guarantees of rendering free medical care to citizens for 2018 and the planning period of 2019 and 2020 The program of state guarantees of rendering free medical care to citizens.
2. If not, review the territorial programs on the website of the local Ministry of Health or TFOMS.
3. Locate the site of Ministry of Health standard for assisting in disease: Select the drop-down menu of the class, then find it in the list.
4. Learn standard. Here you'll find the services that are provided for the diagnosis (section 1) and treatment (Section 2) of the disease. All of them, if necessary, should be provided to you free of charge.
What if the service is necessary, but it is denied
According to a senior lawyer of European Law Offices of Oksana Krasouskaya, if you refuse to provide free medical care and to resolve the issue within the medical establishment is not possible, you should consult with complaints:
- in a health maintenance organization, telephone numbers are listed on the insurance policy;
- the Territorial MHI Fund (phone can be found on the organization's website or at the information stands in medical institution);
- the territorial health authorities - the relevant committee, department, and so on;
- CHI Federal Fund (phone card to protect the rights of citizens in the system of CHI - +7 (495) 870-96-80.
Complaints insurance organization will check the quality of care in institutions. If the facts of violations of the rights of citizens will be established, the company can refuse medical institution in the payment services or to demand compensation for damage caused to the insured, through the courts.
Oksana Krasovskaja, a leading lawyer of the European Law Service
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