The health insurance funds: things to know about a doctor's referral
Is the referral valid for 60 or 30 days? Is the referral issued at the end of the year valid for the new year? Which doctor can issue a referral? These are very important questions, because referrals are one of the essential elements for a patient covered by Compulsory Health Insurance to receive a free consultation from a specialist.
The referral is valid for a maximum of 60 days. During this period, the patient must register in a queue for healthcare services. It is recommended to make an appointment with the specialist of your choice immediately after receiving the referral. For the new year, a referral issued at the end of the year is valid if 60 days have not yet passed since it was issued.
A referral for a specialist consultation paid for by the Compulsory Health Insurance Fund (CHIF) is not issued by a doctor on the basis of the patient's request, but on the basis of the patient's need, taking into account the patient's health condition. Without a referral, only emergency care is provided. A referral is not required for a visit to a dermatovenereologist, or if the patient has repeated visits to the same specialist for the same reason, or if he/she has a chronic disease for which he/she is subject to long-term follow-up.
A referral can be issued by both a family doctor and a specialist doctor. Different qualified doctors can issue referrals in different circumstances. For example, a family doctor may make a referral to a specialist if he or she is needed to help assess the patient's illness and prescribe further treatment. A specialist doctor may issue a referral if he or she wants to get an opinion from a doctor of the same professional qualification or a specialist of a different professional qualification, e.g., a cardiologist who has consulted a patient and decides that a vascular surgeon or an endocrinologist is needed etc. In addition, only specialist doctors providing secondary or tertiary care have the right to make referrals for expensive tests or procedures.
If a doctor refers a patient for a radiology consultation and needs radiology images as well as a description of the radiology examination, he/she must mention this in the referral.
It is important to know that if a patient has a referral for example for a thyroid function test, he/she will not be able to get a free kidney or abdominal function test at the same visit.
After the doctor has examined the patient and prescribed tests, procedures and medicines, the answer must be given to the referring doctor, who will take care of further treatment. The response must include the results of the tests and procedures carried out.
The patient's family doctor determines whether the patient has access to home care services and issues a referral. When the referral is made to a home care provider, a nursing team arrives at the patient's home to assess what care is needed, draw up a care plan and provide the necessary services. In this case, only one referral from the family doctor is needed for all home care services.
Both the medical institution that issues the referral and the one that receives the referred patient must have an agreement with the Territorial Health Insurance Fund (THIF) on the reimbursement of the services provided by the CHIF.
Referring doctors must inform the patient about where the services the patient needs are available. In addition, information on the facilities contracted by the THIF can be found on the website of the health insurance funds.
Consultation on these and other issues can be provided by calling the common health insurance funds information number (8 5) 232 2222 or by e-mail at [email protected].
(Freepik photo)
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Your questions are welcome by email[email protected]or phone: local (8 5) 232 2222, international +370 5 232 2222
Last updated: 22-02-2023
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