14.11.2019

“Muscovites will not be treated”: travelers refuse to serve by compulsory medical insurance

To be ill on vacation, of course, no one plans. But life makes adjustments in our plans. Several years ago, the country introduced a policy of compulsory medical insurance (MHI) of a single model, which theoretically guarantees the provision of medical care throughout the country. However, Russians who left the city for their urgent medical help, asked to pay for it.

… The family of Muscovites Belovy spends the whole summer at the dacha. “One night, I had a toothache of wisdom. Literally on the wall climbed. In the morning I ran to the nearest polyclinic, where I was taken aback: say, my policy in the Kaluga region does not work, you can only remove the tooth for money. And rolled out such a sum that I did not at first believe in such impudence, “- complains Elena. As a result, the woman went to a commercial clinic. It was much cheaper than in the state.

"Muscovites will not be treated": travelers refuse to serve by compulsory medical insuranceElena is not alone. As the head of one of the insurance medical organizations (SMO) Dmitry Tolstoy, there are many such examples. It is worthwhile for a Russian to travel outside of his region, as he is trying to rob him as a sticker. “Often money is asked for the provision of dental services included in the basic program of CHI, explaining this by saying that” insurance does not cover this. ” But there are more complicated cases. One lady, who went on vacation, was asked to pay for a contrast agent during an MRI scan according to the indications. She complained to the SMO; examination showed a violation of her rights, but the clinic refused to voluntarily return money. In such cases, insurance representatives help to issue a claim to the clinic: the case is won, the money is returned.

Insurance medical organizations prepared a rating of health problems. The hot ten included catarrhal diseases (ARVI, bronchitis), traumas of various complexity (abrasions, bruises, dislocations, fractures), urgent conditions (inflammation of the eyes, ears in water), food poisoning and other disorders of the gastrointestinal tract, overheating in the sun , sunburn, acute toothache and exacerbations of dental diseases, allergic reactions and diseases, snake bites, ticks and exacerbations of cardiovascular diseases.

With Russians traveling to rest in other regions, they often demand money for providing even basic medical care.
Specialists composed and top-10 violations of patients’ rights in medical organizations during the holidays, with complaints to which Russians turn to insurance organizations. In the first place – the refusal to provide emergency medical care due to the fact that the citizen, being in another region, forgot the policy of CHI at home. On the second – the requirement of re-registration of the policy in the territory of temporary stay. The third – the requirement to pay for services rendered to the OMC system when a policy is presented from another region.

The MHI policy guarantees the provision of free medical assistance under the basic program throughout the territory of Russia. When planning a trip to another region, be sure to take the original document with you. If your rights are violated, for example, you are required to pay for treatment or denied medical help, contact the administration of the medical institution or the representative of the insurance company that issued you the MHI policy.

– In all cases of conflicts in medical institutions, violations of your rights, as well as in any matters related to obtaining services in the CHI system, you should first contact your insurance company. The hotline number is indicated on the MHI policy, says Dmitry Kuznetsov, vice-president of the All-Russian Union of Insurers. – I recommend to make it in memory of your phone. On the territory of temporary residence, patients may face the fact that they will be denied free medical care or, for example, they will be asked to pay a visit to a “narrow” specialist. In these cases, first of all, you should contact the administration of the medical institution. Refusal to provide medical assistance included in the basic program of CHI, only on the grounds that a person is registered in another region, is illegal. If the appeal to the administration did not help, you can apply to the “hot line” of the territorial MHIF fund, whose phone number can be found on the website of the Federal Compulsory Medical Insurance Fund or information stands in the medical organization. If you are required to re-register the MHI policy on the territory of a temporary stay, you do not need to do this, because in the future you may have problems getting medical care in your hometown.

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