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By understanding the healers’ concerns about their health, the prospects for recovery after overcoming the coronavirus, health insurance funds point out the most important things that can come in handy when visiting medical facilities.
“We always encourage people to take an interest in health financing. In fact, the legal framework is mixed and quite complex, so it is sometimes difficult to see a clear line between free and paid services. However , specialists from health insurance funds are ready to help explain any confusing situation, “says Tatiana Golubayeva, deputy director of the State Health Insurance Fund of the Ministry of Health (VLK).
According to her, illegal payments in medical institutions is something intolerable, so advertising is the best antidote in this case.
“The coronavirus is a treacherous infection, some have a mild form of the disease and others suffer from serious illnesses accompanied by long-lasting complications. Recently, the Ministry of Health has often been asked if there is any special follow-up treatment available for those who have had a coronavirus infection and how to return to a normal rhythm of life as soon as possible. It is important to note that all people who still need medical care after the disease, must first go to their family doctors to obtain these services, “he says Rasa Biekšienė, Head of the Division of Primary Health Care and Nursing of the Ministry of Health (SAM).
Health insurance is equally valid
Therefore, it should first be noted that all policyholders with mandatory health insurance are subject to the same conditions and requirements for the provision of medical care, including those in treatment or in recovery from COVID-19.
The first step in both coronavirus disease and recovery, but if you have any complaints, is to see your GP. Since the treatment case of each patient is individual, the family doctor assesses the medical condition of the patient in each case and decides, according to his competence, which tests should be carried out.
“Patients who are concerned about their health often want to make their own treatment decisions, ask the doctors to do one or another exam and have a specialist examine them. The possibilities for family doctors are considerable, really. they have a lot of research in their competition. So we have to rely on more family doctors, “says Golubayeva.
According to her, if the exam is appointed by a family doctor, the PSDF reimburses the costs of these services and the person cannot be required to pay more. Only if patients who are entitled to PSDF-funded healthcare choose to take the test on their own initiative, will they bear its real cost.
“In all cases of uncertainty, the family doctor may consult a specialist of any professional degree regarding the performance of tests that are not within the competence of a family doctor, as well as for health problems of patients with COVID -19 who are too competent, “says Golubayeva. These consultations can also take place remotely.
When referring to a specialist, the patient must undergo all necessary tests prescribed during the specialist’s consultation to diagnose, prescribe or adjust treatment. Only if the medical specialist does not prescribe the tests during the consultation and the tests are chosen by the patient himself, should he pay the actual cost of the tests.
“Antigen and antibody testing is recommended for people with a history of ongoing complications. Unfortunately, these studies are not reimbursed by state funds today. However, we are doing our best to resolve this issue in the near future and, if a family doctor prescribes the mentioned tests, a person should not have to pay for them “, says R. Biekšienė, representative of SAM.
The message for those who really need rehabilitation: to allow patients to have access to a wider range of services (massage, physical therapy, occupational therapy and physical therapy) as soon as possible after COVID-19, and to bring them as close as possible to the place of residency, physical medicine and rehabilitation reorganized into first stage ambulatory medical rehabilitation services. Because first-stage outpatient rehabilitation services are available for a large number of diagnoses, including those related to lung disease, people experiencing the effects of the coronavirus are eligible for this PSDF-paid treatment.
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