What is the treatment of OMS. What tests can be passed free of charge on the Polish OMS? About free medicine

By polish OMS You can hand over for free analysis for the diagnosis and treatment of most diseases. Forcing the patient to pay for tests in most cases illegally, but in order to avoid excess spending or return funds for paying procedures in state clinics, it is necessary to know the legal foundations of interaction between medical institutions, their patients and an insurance company.

What tests can be passed free

The procedure for providing citizens of free medical devices on MSE polisms is regulated by the following regulatory acts:

• law No. 326;
• Resolution No. 1403;
• laws of subjects of the Russian Federation.

All citizens of the Russian Federation, who received the Policy of the OMS, guaranteed medical assistance, both in the basic and additional (regional) programs. The main program includes not only the treatment of pathologies established by the doctor, but also timely identification of such pathologies, as well as preventive measures.

The list of diseases subject to free therapy throughout the Russian Federation is briefly represented in paragraph 6 of Art. 35 of Law No. 326, but in more detail in the list of section 4 of Resolutions No. 1403.

Free are analyzes appointed for the following purposes:

1. treatment of pathology present in the list;
2. diagnosis of this pathology;
3. diagnostics of possible accompanying pathologies;
4. prevention of suspect pathology and concomitant diseases.

For example, the doctor according to the described patient symptoms suspects a specific pathology, which is often accompanied by another pathology. If the analyzes for the presence of the main disease are free, then the tests for the presence of a concomitant disease should also be carried out in the framework of services paid by the insurance company.

The main medical standards for which the treatment of diseases listed in the basic and additional programs, can be found on the website of the Ministry of Health of the Russian Federation.

Among the main free types of analyzes, the following can be distinguished:

• blood test for syphilis - markers, HIV, and other infections;
  blood tests and plasma on the content of the main elements (red taurus);
• biochemical blood tests and lymphs;
• analysis of hormone content;
• tissue biopsy;
• high-tech analytical studies of tissues and organs (MRI, CT);
• x-ray studies;
• ultrasound tests of tissues and organs;
• squeezes and smears of skin cover, extreme flesh and saliva.

Only expensive tests may be paid with suspicion of rare autoimmune or genetic diseases, which are less common than 0.01% of cases, as well as analyzes aesthetic medicine.

How to check whether the analysis is free

To determine the legality of the director of the doctor to surrender paid analyzes, it is necessary to find out whether the necessary analysis is included in the list of services provided on the basic insurance program.

It is important to know that the basic list of medical services provided throughout the country can be complemented by:

• regional medical programs;
• employer programs.

Regional programs are budget subventions for the payment of services that are not in the All-Russian List, and which are free only in a specific subject of the federation. To obtain these services can only patients with register in the region and received an insurance policy from local insurers.

In addition, major employers paying insurance contributions for their employees can provide additional packages Free surveys services.

To verify the ability to pass the assigned to the doctor, the analysis is free of charge to perform listed actions:

1. To see the presence of a proposed physician pathology in the main list approved by Decree No. 1403.
2. In the absence of a disease in this list, find out its presence in the list of services provided by insurers of the region or the employer of the patient.
3. To find out the list of analyzes necessary for the diagnosis and treatment of this disease from the standards on the Ministry of Health.

The list of additional regional services can be found on the website of the regional Ministry of Health, and services provided by insurance from the employer are listed in the annex to the employment agreement.

If the diagnosed disease is in one of the free programs, and the designated analyzes are included in the standard of treatment of this disease defined by the Ministry of Health, then the patient has the right to give this analysis for free.

How to get a direction

At the initial reception, the patient is often given a direction for tests in a paid clinic under the pretext of the absence of the necessary equipment or reagents in this clinic. It is important to know that only the patient has the right to choose the place of providing medical services. The doctor can only give direction to the analysis, and the place of passing and processing results is determined by the patient.

Obtaining a direction for free tests is as follows:

1. the patient appeals to a specialist doctor for diagnosing the disease;
2. the doctor determines which analyzes must be passed to the patient and gives the direction;
3. in the absence of ability to analyze in this clinic, the doctor issues a direction to another medical institution;
4. in case of refusal of an employee of the clinic, give a referral to a free analysis, it is necessary to write a complaint to the name of the head or chief physician.

If the appeal to the clinic manual did not bring results, and the necessary analysis is included in the list of basic or regional services provided by the Policy of the OMS, the patient should be contacted to the representative of its insurance company.

You can contact as with help hot lineand personally, to the representation of this insurer in the village. In most insurance companies, there are special departments whose work is aimed at solving conflicts between medical institutions and patients.

If, after the attempts taken, the direction for free analysis is not received, then contact the regional fund of the media. Such funds control the activities of private insurers in the context of compliance with the rights of insured patients.

In some cases financial resourcesThe patient spent on the surrender of free analyzes can be returned. You can return the funds by 2 ways:

• at the checkout clinic;
• in the insurance company.

If the patient was sent to passing a paid analysis in the clinic of appeal, then the following should be done to return funds:

1. make an application addressed to the chief doctor about return money;
2. attach to the application for a check on the payment of analyzes and the agreement on medical services rendered;
3. get an order resolution on compensation;
4. contact a copy of the order and the passport in the accounting department of a medical institution.

The statement indicates the full name of the patient, its address on registration and passport data, then you need to state the grounds for returning funds, indicate the amount spent and number insurance Polisa.. The basis should indicate the presence of a prolonged analysis in the basic list of services that the OMC policy owners may apply.

To return funds, it is necessary to maintain a check receipt for payment for services and a paid service agreement.

If the patient was sent to a private clinic for testing, the return of the spent money is carried out through the insurer who issued the policy. For this, it is necessary to apply to the representation of the insurance company of the municipality and draw up an application for the return of funds on the basis of the offensive insurance case - the need to pass the analysis from the basic or additional listings.

The transfer of money through the insurance company is usually carried out within 3-8 business days. If the contributions for the OMS policy pays the employer, then compensation can be listed through the enterprise's cash desk or on a salary card.

Sophisticated situations

When referring to compensation or upon request of the issuance of the direction to another medical insurance, the patient may encounter a failure or strong delay in the response to appeal. In most cases, the situation helps to resolve the call to the experts of the insurance company, which issued the policy, or a complaint to the OMS Regional Fund.

If the assigned analyzes are included in the base list and are expensive procedure, the patient has the right to require the provision of this service for free through judicial authorities. It is important to take into account that the direction for tests in another locality Or a paid clinic can be issued only under the following circumstances:

• lack of opportunity to conduct data from research in state clinics of this municipality;
• no lack of this moment necessary specialists in the clinic;
• lack of assigned analysis in the basic and additional lists paid services;
• appeals from another region for the service provided within the framework of the Federation Subject.

The doctor must inform the patient about the free analogue of any medical service provided. Often patients are cheating, giving a direction for paid tests with the promise of subsequent compensation for which the patient will not have the right in connection with the personal refusal of the free service.

To avoid such a deception, you need to carefully view the treaty proposed for the signature when passing paid tests for the presence of a refusal point for free services. If there is this point, it is possible to return the money spent only by court decision.

If a patient, when providing a paid service, refuse to issue an agreement and a check, should be refused to pay and turn with the complaint to the chief doctor and in the insurance company, since the data of the personnel are illegal.

Conclusion

Most of the analyzes in state clinics holders of OMS policies can take free of charge. To realize your rights, you should look for an appointed analysis in the list of free services and, if necessary, to demand directions to another medical insurance, and it is important to maintain a copy of the contract and receipt to retain the means. Most of the difficult situations are solved by applying to representatives of the insurance company.

Often unforeseen is for many people the need to perform an operation, which can happen to the person himself or his close surroundings. He facilitates the situation of insurance if the necessary intervention implies payment within its coverage. FREE OPTION OPERATION OMS includes payment of the manipulations themselves, examination, drug provision. Read more about these and other important issues.

Basic Medical Assistance Program is part unified systemproviding social guarantees to citizens Russian Federation, as well as certain categories of foreigners or stateless persons. In addition to the federal, the regions offer the territorial whose volumes depend on the funds allocated. List of operational interventions that can be performed as assisting citizens within the mandatory medical insurance It is open and accessible to familiarize.

All innovations are sent in a timely manner to insurance companies, medical institutions. It is important to keep in mind that not all events covers insurance, various services are also provided depending on the SC. To find out what events will be free, and for which you have to pay, you can contact your doctor or to the insurer with whom a contract has been concluded.

What operations can be done

In 2018, the list of free operations is large and divided depending on the direction:

1. Eyes. Treatment is paid at:

• cataract Crustalika
• country squints, including rybism
• glaucoma
• congenital anomalies
• retina deformation due to injury

1. Nose. Operations on it relate to the correction of the nasal partition (stenoplasty), which caused the impairment of the function of respiration, while loss of sense of smell, edema of the mucous membrane, susceptibility to painting diseases, with snoring, drying in the nose and pain
2. Removal of the gallbladder with cholecystitis, cholesteroz, gallstone disease
3. Operation of Marmar for men in the case of varicocele 2, 3 stages, the impossibility of severvasion, pain, aesthetics
4. Gynecological diseases
5. Arthroscopy joints
6. Operations of Ven.
7. Breast Department, including oncological diseases
8. Valgus Stop.

Diseases that are treated with a lot of surgery. The listed list is not complete. Based on the situation, it should be sought in the list of those treated by oMS program and covered by a specific insurance company, since restrictions can be.

Important! Surgical cosmetology does not apply to free services.

Who can receive free medical services

Medical assistance according to OMS is throughout Russia, citizens who have issued an insurance contract. At the same time, help is without reference to the place of residence, but restrictions can be, since the list of services is more advanced for residents of their region. Also assistance is to people:

• awarded on licensed, scientific, publishing contracts
• we made an employment contract with enterprises in terms of production, consumption and distribution of benefits
• farmers
• involved in the production of folk goods, generic economic activity
• the unemployed, to which children under 18, children's guardians age up to 3 years old, persons dealing with disabled people with 1 group or adult after 80 years
• health workers, specialists from other special organizations, military personnel
• foreigners working officially
• refugees

Important! If there is no information about the insured person in a single database of the FOMS, and it cannot confirm this by the policy, in the provision of free help have the right to refuse.

Where you can undergo treatment free of charge

Medical assistance in OMS turns out to be throughout the country. This applies to the emergency provision of services, with a planned, unscheduled handling. The main condition is the participation of a medical institution in the FOM system, fixing the clinic. There may be only a service limit, as the amount of activities for those patients who are undergoing general reasons or by the Regional Program. In the latter case, more expensive services are paid, and the list itself is greater.

The medical institution becomes a member of the program immediately after the signing of a cooperation agreement under medical insurance. If his quota is, then they will not have rights to refuse to provide services. Disasseaving the issue of the provision of services, you should know and remember that the planned operation may require waiting time in turn. This is due to the limit of quotas, that is, the payment of operations, as, as a rule, they are expensive, but there may be many wishing. A similar situation with some types of surveys. For this reason, it is necessary to apply to the next region or a private clinic.

Choosing a hospital for holding a planned operation, pay attention to such factors:

1. Insurance cover. She may not spread to this species Operations (the situation may be another in another insurer, which depends on the list of services and coverage).
2. Location. In metropolitan clinics, modern equipment can be white, in local, there may be more experienced doctors.
3. Waiting time in turn. In large cities with a large population density, you can wait for the year. During this time, the health situation may worsen. In other cities, the deadlines are somewhat smaller, which will speed up the process aimed at recovery.
4. The cost of activities that need to be paid additionally to those procedures that will cover insurance. There are also important points such as travel, residence of relatives, since the further the hospital is, the more substantial costs are.
5. The possibility of counseling. In order to quickly rehabilitate, recovery after surgery, it is important to be able to observe and learn about the measures appropriate for a particular person in his situation.

How to arrange a quota for a free operation - actions algorithm

To get a quota for a free OMS operation, it is important to comply with some sequence of actions in which such steps include:

1. Visit the doctor in the clinic at the place of attachment for inspection, directions to the examination, for surrenders.
2. Based on the information received, the general state of the patient, the doctor will be able to write a direction to the clinic, where the operations of the right direction are performed. If the patient insists on a certain medical institution, the direction can be written in it.
3. Visit the profile hospital to register if this is put on the terms of the clinic, to make an appointment with the doctor.
4. Arriving at the appointed time, take personal documents confirming the identity, direction from the doctor and all the information relating to their health: results for surveys, analyzes, insurance. After examining, having studied the medical records, the doctor decides on the need for treatment, the placement of the patient in the hospital. Also in his competence, informing a person about the list of free, paid services. Additional tests may be assigned to the place of operation.
5. Within 10 days, a person informs about the date of execution of the operation.
6. At the appointed period is held hospitalization.

The number of quotas is determined based on the financial resources of the FOMS, individual regions to compensate for the cost of consumables, medicines, the work of medical staff, performed surgical intervention. If the medical institution is state, then its activity depends on the financing, including the purchase of all necessary, including equipment. For this, it is important to conduct competitions to determine the most favorable sentences. For this reason, to obtain assistance within the framework of the OMS, one should not count on the use of the recent generation consumables, everything is selected the most optimal, effective to assist and recovery.

Documents are needed

Documents confirming the feasibility of performing treatment with surgical path, including for the passage of the CHA program, should relate directly to the personality of the patient, medical documents relating to his health. This list includes:

• direction from the attending physician for operation
• extract from the medical history
• results of surveys
• data on analyzes
• passport
• original insurance policy
• SNILS
• checks in case of performing any payment (for medicines, examination)

Whether to pay extra for the provision of services

As already mentioned, surgical measures are free. In addition to the work itself, costs of anesthesia, consumables, the use of special equipment are covered. If additional payment requirements are set, it is illegal. Independently financed passages, accommodation, meals outside the hospital. Payment is subject to services that do not belong to the list provided by OMS:

• perform an anonymous diagnostic optional (except HIV)
• diagnostics, procedures in the field of sexopathologies
• speech therapist for adults
• vaccinations except those belong to the OMS provided
• departure to the house with the purpose of counseling, diagnosis, treatment, except when a person has no physical opportunity Arrive in the hospital
• postoperative procedures, which also applies to sanatorium treatment, unless it is included in the OMS
• cosmetology
• psychological support
• prosthetics, except services included in the OMS coating
• methodical assistance related to patient care

The duty of medical institutions is informing patients not only about free services, but also about paid. It is useful to use the price lists that are hanging on special stands in the receptions. When fulfilling hospitalization can inform about the possibilities that are provided for an additional fee and which may affect the hospital. To clarify the requirements that are offered, the patient has the right to appeal to the insurer. This concerns and pay for services, drugs.

In what cases can refuse and what to do

There are not rare situations when a person refuses the fulfillment of a free operation. Money for services may also be required. In such a situation, people may agree with the statement, but also they have the right to receive a written substantiation of refusal and familiarization with established conditions and order. At the same time, the patient protects his personal rights as a citizen who has aroused the insurance policy. He can contact:

• to the insurer
• to the head doctor
• in the district or city \u200b\u200bgovernment Health
• territorial, Federal Department of OMS
• to court

To obtain a reasonable decision on the complaint, you need to write a written application, which is important in detail, clearly, in the business style, state the essence of the problem. It is also indicated:

• FULL NAME, the position of person to which
• FULL NAME, the place of residence of the face whose rights were violated
• insurance Policy Data
• data (details) of the hospital, in which the service was denied and in which there is a violation
• the time during which therapeutic measures were carried out, there was a person on treatment
• list of events that led to unreasonable trust of personal funds and their cost

When filing complaints, evidence confirming the correctness of the applicant is necessary. These include extracts from the history of the disease, checks on payment.

Conclusion

The population assistance system is not one year, improving annually and providing better services, more quotas. To be serviced free, it is advisable to consult with the attending physician who will prompt the correct decision in an individual case. Do not forget about the possibility of treatment and in other regions, since the queue "at home" can lead to complications, and "next door" will be fulfilled faster, it will make it easier and will speed up recovery.

Video: free prosthetics on the policy of the OMS

Within the framework of the OMS, surgical treatment is carried out only in the direction of the polyclinic (form 057 / U-04) ... see forming Without direction, the cost of services according to the current price list. Some treatment services under the hospital are charged additionally. The number of quotas is limited.

1. Contact the Hospitalization Commission "Nimz Medika-Menthe". The presence of indications for hospitalization in the hospital is determined by the Commission on the basis of the provided document package:

• from patients with cardiovascular pathology - an extract from an outpatient card, CT with contrasting, angiography, ultrasound, etc.
• from patients with traumatuary-orthopedic pathology - extract from an outpatient card, CT, MRI, X-ray, ultrasound, etc.

2. Contact urban clinic at the place of residence with a statement addressed to the chief doctor of the Polyclinic (download a sample application) and get the direction in form 057 / U-04 to hospitalization, for inpatient treatment and an extract from the outpatient card in form 027 / y.

* According to №323-ФЗ, any person who has Russian citizenship and a policy of a Russian sample may apply for medical care to any institution.

Normative base:

• Federal Law of 21.11.2011 N 323-FZ (ed. From 28.12.2013) "On the basis of the health of citizens' health in the Russian Federation" (Article 21. Choosing a doctor and medical organization).
• Order of the Ministry of Health of Russia of December 21, 2012 N 1342N "On approval of the procedure for choosing a citizen of a medical organization (except in cases of emergency medical assistance) outside the territory of the constituent entity of the Russian Federation in which a citizen lives, when providing him with medical care under the program state guarantees Free provision of medical care. "
• Order of the Department of Health of Moscow of 02.11.2009 N 1400 (Ed. From 07.08.2013) "On the organization of providing and taking into account fixed medical care nonresident, as well as foreign citizens in medical organizations Health Department of Moscow.
• Order of the Moscow Department of Health from 11.10.2012 N 1090 "On Amendments to the Order of the Department of Health of the City of Moscow of 02.11.2009 N 1400" (together with "Instructions on the procedure for organizing the provision of stationary medical care to nonresident and foreign citizens in medical organizations in the Department of Healthcare Cities of Moscow ").

3. Before hospitalization, you need to undergo an examination in accordance with the program issued by you the necessary preoperative examination (the survey is carried out in your clinic at the place of residence or any other medical institution outpatient).

4. Hospitalization is carried out strictly at the appointed time in the presence of all necessary analyzes, the results of surveys, correctly executed areas!

Preparation for surgical intervention in private clinic Differs from normal speed and price. If the patient plans to take advantage of its right to free medical care, he will have to prepare for a long expectation. Pause before hospitalization on a planned operation can last to six months, but despite the duration of the procedure, to implement it in common order is quite real. However, it should be noted that federal budget Not always covers all expenses. For example, the search for the donor is carried out by the patient at its own expense. Is it possible to count on free operations on the Policy of the OMS? What categories of citizens are free operations rely? How to get a direction on surgical intervention? We will try to answer these and other questions in this article.

What operations rely free?

The list of free OMS operations is revised and complemented annually within the framework of regional health programs. Further, this information is descended from above to those medical facilities that provide this kind of service. This list is open and subject to hanging on information stands in clinics and hospitals. At the Policy of the OMS, any citizen of the Russian Federation (employed, unemployed, child, newborn) can get a free operation in the case of:

• Gynecological diseases (mioma, infertility, cyst);
• Surgical (hernia, cholecystitis);
• Urological (cyst, adenoma, urolithiasis);
• Diagnosis of prostate cancer (prostate biopsy);
• Chest surgery (cancer diseases, mediastinum and pulmonary pathology).
• Varicose disease;
• Reconstruction of the foot.

It should be noted that this is only a brief list of all possible medical services in the policy. Every year, the list is replenished not only by diseases, but also clinics that provide free treatment with high-tech equipment. To fully familiarize yourself with the list, you should seek help from your doctor or to the head of the department in the hospital. Also this information has insurance Company According to OMS, whose manager can answer all the questions on the hotline.

How to get a direction?

In order to get to the free operation, first need to make sure that it enters the list of services provided by OMS. And further the procedure is quite simple, although receiving the direction on preferential operation And it will require some time. So, the insured person will have to go through several stages:

1. Record to your doctor, receiving primary consultation and directions for the examination.
2. Delivery of the necessary analyzes.
3. The appearance of the reissue to the doctor with the results of analyzes, receiving the direction to the Commission to the medical institution.
4. Passing the qualifying committee on a designated period.
5. Turning on the third reception at the attending physician in the hospital, receiving a direction to hospitalization.
6. Delivery of analyzes before registration in the hospital.
7. Registration in the hospital.

In the hope of free treatment will have to sit out impressive queues. The timing of the decision on hospitalization may last for half a year. After 6 months, the patient has the right to write a complaint in the FOMS. If a citizen wants to operate in any particular hospital, he should voice his wishes at the first consultation at the attending physician. The therapist can take into account the request of the patient when the direction is discharged if the specified institution has the ability to carry out a free operation on the OMS policy. The final decision on the patient's distribution is adopted by a specialist, so the patient's wish may not coincide with the actual assigned point of operation.

Recovery after surgery

After the free operation, an additional gratuitous rehabilitation is also assumed to the patient. How to get it? For this you need to come to your doctor, get the direction for an additional inspection and laboratory research And after receiving results, it is possible to issue a ticket to a sanatorium-resort institution for recovery, of course, if the results of the study allow it. At the same time, rehabilitation activities may refuse due to complications after the treatment of venereal, oncological, psychiatric diseases, incapacity, drug addiction or alcoholism.