The residents often apply to the National Health Insurance Fund (NHIF) when faced with questions whether a particular service must be provided free of charge at a medical institution, whether it is legitimately requested to pay for the service. The specialists at the NHIF remind that individuals covered with the Compulsory Health Insurance (CHI) are entitled to health care services paid through the Compulsory Health Insurance Funds (CHIF) at the institutions that have entered into contracts with the Territorial Health Insurance Funds (THIF). However, there exist exceptions when the patient will have to fully pay or pay a part of the costs for the services. What are these cases?
"We note, first of all, that the patient has the right and the duty to know about free and paid services, and about the services that require partial payment. Therefore, even the contracts of the THIF with medical institutions stipulate the services provided to the patients and paid from the budget of the CHIF for which medical institutions undertake not to charge additional fee.
The medical institutions are also required to make publicly available in an easily visible place, such as reception, information board and website, information of the medical services provided which are paid from the budget of the National Health Insurance Fund", – says Birutė Kavaliauskienė, the Chief Specialist of the Service Expertise and Control Division of the NHIF.
However, there are still cases where the patients are offered to pay for the consultations of medical specialists, various tests and examinations, and, when inpatient treatment is required, to bring medical aids or medicines.
According to the legislation, payment for services in medical institutions is only legalized in some cases.
First of all, services that the patients have to pay for, even when they are covered with the CHI, are listed on the list of paid services. For example, for cosmetic surgery interventions and cosmetology procedures, abortion, dental implantation, acupuncture and manual therapy, medical examination when travelling abroad, of those who wish to acquire a weapon, and of those who wish to obtain drivers and aviators certificates, etc.
"The patients are also entitled to paid services without the need to wait in a queue. When the patient does not want to wait for the offered scheduled test / examination or procedure, and wishes to be provided with the service without the need to wait in a queue, such patient must pay for the services. If the patient wants to get a free service, the patient must be registered by the medical institution which has to indicate a specific date when the service will be provided. Furthermore, in this case, the administrative staff of the medical institution must provide information on other medical institutions where the free services that the patient requires can be provided more quickly", – notes B. Kavaliauskienė.
The patient must also pay for the services if the patient wishes to consult medical specialists without being referred by a general practitioner or medical specialist.
Partially paid services
If the patient entitled to free health care services voluntarily opts for more expensive services, materials, procedures when offered by the physician, such patient must pay for the difference between their actual prices and the prices of free services, materials and procedures.
And if the patients opt at their own initiative for additional services or procedures not related to the treatment of the underlying disease, such patients must pay their full price.
"Please note that the services for which the patient is not given an alternative, i.e. when there is no possibility to choose between a free service which is compensated through the budget of the NHIF and the service which costs more, cannot be attributed to these services. The NHIF often receives complaints from the patients that they were offered, for example, only a more expensive surgical intervention without being offered any alternative. There are also instances where, based on medical indications, a more expensive surgical intervention is the only service appropriate for that patient. Then the service has to be provided free of charge, without the need to pay an extra fee – it is paid from the budget of the CHIF", – emphasizes B. Kavaliauskienė.
According to her, patients should keep in mind that all medications that they receive during hospital treatment are included in the cost of treatment which is compensated from the budget of the NHIF.
If the patient is advised by the physician, who is responsible for the treatment of the patient, to use newer, better or more expensive medications or treatment technologies, and the patient agrees, then the patient has to pay the difference between an amount of the service paid from the budget of the CHIF and the version offered by the physician and chosen by the patient. If the patient agrees to pay the difference, this has to be confirmed with the signature. Full price has to be paid only for the services that the physician deems unnecessary and therefore does not suggest them to be provided.
"There are also cases where physicians of inpatient departments recommend that patients purchase medications by themselves or bring medical aids. However, the patients should be aware that this is not regulated by law and is illegal.
For example, the NHIF often receives complaints from the patients that they are strongly instructed to purchase disposable clothing prior to Magnetic Resonance Imaging (MRI), and to acquire a video copy of the examination even though it is not specified by the physician in the referral that such copy is necessary.
Please be reminded that for the individuals who are covered with the CHI and referred for the medical procedure by their physician the costs of measures that are required for MRI are included in the total cost of the examination, and it is paid from the budget of the NHIF. So patients do not have to pay any extra fee", – says the specialist of the NHIF B. Kavaliauskienė.
Where to pay?
If the patient has chosen a paid or partially paid service, first of all the patient should be explained why, for what and how much the patient will have to pay. In addition, records of all these facts must be made in medical document and confirmed with the physician's signature. Only then the patient must sign his or her consent for paid or partially paid services. Payment for the service should be made in the cash register of the medical institution.
"It is important to know that after having signed in the medical records to confirm your consent to pay for medical services or to purchase medicines or medical aids at own expense, you will not be entitled to claim later damages from the medical institution.
Therefore, if the patient has any questions or concerns about paying for services, before signing the documents the patient should contact the administration department of the medical institution", – warns B. Kavaliauskienė.
Please be reminded that all information about the services financed from the budget of the NHIF is available on the websites of the NHIF and THIF. In case of any questions, the residents may always call the customer service number (8 5) 232 2222 or write an e-mail to email@example.com, and may also seek advice at customer service divisions in Vilnius, Kaunas, Klaipeda, Panevezys, and Siauliai.
The NHIF invites you:
Your questions are welcome by email firstname.lastname@example.org or phone: local (8 5) 232 2222, international +370 5 232 2222