2024-07-04 08:25:12
In the event of visual disturbances, the patient must first contact his family doctor, who will assess the vision and, if necessary, write a referral for an ophthalmologist’s consultation. Once a cataract is diagnosed, surgery is usually required.
Patients who have a referral for an eye lens replacement surgery, in order to receive this service paid by the Mandatory Health Insurance Fund (PSDF), can apply to any public or private medical institution that has signed a contract with the Territorial Health Insurance Fund (TLK) for cataract surgery.
What is important to know for a patient awaiting lens replacement surgery should be informed by the attending physician. A patient insured by PSD must first be offered a free operation, since PSDF pays the basic price for the treatment facility for the operation. Its price includes the average cost of purchasing an eye lens, so the patient does not need to pay for the artificial lens separately.
Unless he himself wishes to have a more expensive lens offered by the institution and recommended by the attending physician implanted. Then, the patient needs to pay not the full price of the lens, but only the price difference between the chosen lens and the lens paid for by the PSDF.
According to the data of the State Sick Fund, about 32 thousand surgeries were performed last year. cataract operations, it took almost 19 million EUR from PSDF.
Health insurance specialists still have to hear that medical institutions refer to compensated contact lenses to patients as being of lower quality, which is why they offer to purchase more expensive and better ones. It is useful for patients to know that the medical institutions performing cataract surgery in both inpatient, day surgery, and outpatient ophthalmology surgery conditions purchase eye lenses themselves, so they must purchase them of good quality. Also, PSD institutions must ensure that cataract surgery is available free of charge to all insured persons.
When informing the patient about the possibility of receiving a free eye lens, the use of which is medically justified according to the patient’s health condition and which would help solve the patient’s health problem, the attending physician must explain that there is no additional charge for it. Only if the patient refuses a free service, the institution has the right to offer to purchase another one.
There are cases when patients are required to purchase lenses for cataract surgery at pharmacies. It should be noted that if the patients themselves buy lenses at pharmacies or medical institutions and pay their full price, the health insurance funds do not compensate the patients for the costs.
In addition, there is no legal possibility for a medical institution to provide a healthcare service paid for by the PSDF with the patient’s own medicines or medical aids purchased elsewhere.
At the treatment facility, the patient must receive all the information he needs about the services paid for by the PSDF and provided free of charge to the insured. If there are questions about why or for what the insured PSD is being asked to pay or co-pay, you should ask the doctor. If it is not possible to find out, the next step is to contact the administration of the medical institution. If the administration of the treatment facility is unable to find out whether it is legally required to pay or co-pay for something, you can apply to the ITC.
Medical institutions that have concluded contracts with ILC must publish important information about the services provided by the medical institution for which the health insurance funds pay with PSDF funds, applicable premiums, provided paid services and their prices in a place visible to patients.
You can find a list of medical facilities that perform eye lens replacement operations here.
Panevėžys territorial sick fund information
2024-07-04 08:25:12