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15-11-2023

Health insurance funds: eye lenses for surgery must be provided by medical institutions

The National Health Insurance Fund under the Ministry of Health (NHIF) receives more and more requests from the patients to be reimbursed for the cost of eye lenses they have bought at pharmacies. Specialists from the health insurance funds remind patients that all the costs of cataract surgery are covered by the budget of the Compulsory Health Insurance Fund (CHIF), so patients cannot be required to purchase their own eye lenses.

Cataract is a relatively common disease, especially among older patients, where clouding of the lens of the eye reduces vision. The disease is effectively treated by performing a cataract surgery, which removes the cloudy lens of the eye and inserts a new artificial one. These operations and the lenses implanted in the eyes during the surgery are covered by compulsory health insurance for people covered from the CHIF. However, the number of cases, when patients are being asked to buy lenses for cataract surgery from pharmacies, increases. 

“There is no law allowing a healthcare facility to provide a healthcare service paid for by the Compulsory Health Insurance Fund with patient’s own medicines or medical aids purchased elsewhere. Institutions must make their own arrangements to ensure that patients receive quality services”, Tatjana Golubajeva, deputy director of the NHIF, emphasizes.

Patients with a referral for lens replacement surgery can go to any public or private medical institution that has a contract with the health insurance fund for cataract surgeries. The medical facility is paid a reference price by the health insurance funds for the operation, which includes the average cost of the lens of the eye. Facilities performing cataract surgeries in both inpatient, day surgery and outpatient ophthalmic surgery must purchase good quality lenses by themselves and ensure that cataract surgery is free of charge for patients.

It is important to know that an attending doctor must first inform the patient about the possibility of obtaining a free eye lens, the use of which is medically justified according to the patient’s medical condition, which would help to solve the patient’s medical problem and for which no extra charge can be made. Only if a patient refuses, a healthcare institution is entitled to offer a patient another eye lens and to pay the difference between the price of the eye lens covered by the CHIF and the price of a more expensive eye lens purchased by the institution.

Patients, who purchase their lenses by other means, are not reimbursed.

According to the data of the NHIF, more than 23,000 cataract surgeries have been paid for by the health insurance funds this year until October. This required over EUR 13.5 million from the CHIF.

The health insurance funds remind that if there are any questions about why a person is asked to pay extra for an eye lens or an operation in a medical institution, it is important to ask an attending doctor immediately. If a person cannot find out, it is recommended to write to the management of the healthcare facility. If a person is not satisfied with the explanation, he can contact the health insurance funds with the reply he received from the hospital.

(Freepic photo)

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