Often unforeseen is for many people the need to perform an operation, which can happen to the person himself or his close environment. Insurance facilitates the situation if the necessary intervention involves payment as part of its coverage. Free operation compulsory medical insurance policy includes payment for the manipulations themselves, examination, and medication. Read on for these and other important questions.

The basic program of assistance under the MHI policy is part of unified system providing social guarantees to citizens Russian Federation, as well as certain categories of foreigners or stateless persons. In addition to the federal one, the regions offer a territorial one, the volume of which depends on the allocated funds. The list of surgical interventions that can be performed as assistance to citizens under the mandatory health insurance is open and available for review.

All innovations are sent to insurance companies and medical institutions in a timely manner. It is important to keep in mind that not all events are covered by insurance, different services are also provided depending on the UK. To find out which activities will be free and which you will have to pay for, you can contact your doctor or insurer with whom you have a contract directly.

What operations can be done

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

1. Eyes. Paid treatment for:

• lens cataract
• strabismus in children, including strabismus
• glaucoma
• congenital anomalies
• retinal deformities due to trauma

1. Nose. Operations on it relate to the correction of the nasal septum (senoplasty), which caused respiratory dysfunction, loss of smell, swelling of the mucous tissue, susceptibility to respiratory diseases, snoring, dryness in the nose and pain
2. Removal of the gallbladder for cholecystitis, cholesterosis, cholelithiasis
3. Marmara operation for men in case of varicocele at stages 2, 3, impossibility of sperm production, pain, aesthetics
4. Gynecological diseases
5. Joint arthroscopy
6. Vein operations
7. Thoracic region, including oncological diseases
8. Stop valgus

There are many diseases that can be treated with surgery. The list provided is not complete. Based on the situation, you should look for it in the list of those who are treated under the CHI program and covered by a specific insurance company, since there may be restrictions.

Important! Surgical cosmetology does not apply to free services.

Who can get free health care

Medical care according to the MHI is provided throughout Russia to citizens who have drawn up an insurance contract. At the same time, assistance is provided without reference to the place of residence, but there may be restrictions, since the list of services for residents of their region is more extended. Help is also provided to:

• awarded under licensing, scientific, publishing agreements
• issued employment contract with enterprises in terms of production, consumption and distribution of goods
• farmers
• involved in the production of folk goods, generic economic activity
• unemployed, which include children under 18 years of age, guardians of children under 3 years of age, persons caring for people with disabilities of group 1 or adults over 80 years of age
• medical workers, specialists of other special organizations, military personnel
• foreigners working officially
• refugees

Important! If there is no information about the insured person in the single database of the MHIF, and he cannot confirm this with a policy, they have the right to refuse to provide free assistance.

Where can I get treatment for free

Medical assistance under compulsory health insurance is provided throughout the country. This applies to emergency services, with planned, unscheduled treatment. The main condition is the participation of a medical institution in the MHIF system, assignment to a polyclinic. There can only be a restriction on service, since the volume of events for those patients who are on a general basis or according to a regional program. In the latter case, more expensive services are paid, and the list itself is larger.

A medical institution becomes a participant in the program immediately after signing a cooperation agreement under the medical insurance program. If he has a quota, then they will not have the right to refuse to provide services. When reviewing service provision, you should be aware and remember that an elective operation may require queued waiting times. This is due to the limitation of quotas, that is, the payment for operations, since, as a rule, they are expensive, and there may be many applicants. The situation is similar with some types of surveys. For this reason, it is worth contacting a neighboring region or a private clinic.

When choosing a hospital for a planned operation, you should pay attention to the following factors:

1. Insurance cover. It may not apply to this type of operation (the situation may be different for another insurer, depending on the list of services and coverage).
2. Location. Capital clinics may have more modern equipment, while local ones may have more experienced doctors.
3. Waiting time by turn. In big cities with high density population can wait a year. During this time, the health situation may worsen. In other cities, the terms are many times shorter, which will speed up the process aimed at recovery.
4. The cost of events that need to be paid in addition to those procedures that will be covered by insurance. Also important are such items as travel, accommodation of relatives, since the farther the hospital is located, the more significant the costs are.
5. Possibility of counseling. For the purpose of quick rehabilitation, recovery after surgery, it is important to be able to be observed and learn about the measures that are appropriate for a particular person in his situation.

How to apply for a quota for a free operation - algorithm of actions

To get a quota for a free CHI operation, it is important to follow a certain sequence of actions, which include the following steps:

1. Visit the doctor at the clinic at the place of attachment for examination, referral for examination, for testing.
2. Based on the information received, the general condition of the patient, the doctor will be able to write a referral to the clinic, where operations of the desired direction are performed. If the patient insists on a certain medical facility, a referral can be issued to it.
3. Visit a specialized hospital, register, if required by the conditions of the clinic, make an appointment with a doctor.
4. Arriving at the appointed time, take personal documents confirming your identity, a referral from a doctor and all information related to your health: results of examinations, tests, insurance. After examining, having studied the medical documentation, the doctor decides on the need for treatment, placing the patient in a hospital. It is also within his competence to inform a person about the list of free, paid services. Additional tests may also be ordered for delivery at the place of the operation.
5. Within 10 days, the person is informed about the date of the operation.
6. Hospitalization is carried out at the appointed time.

The number of quotas is determined based on financial resources MHIF, individual regions to compensate for the costs of consumables, medicines, the work of medical staff, performed surgical intervention. If the medical institution is state-owned, then its activities depend on funding, taking into account which the purchase of everything necessary, including equipment, takes place. For this, it is important to hold competitions to determine the most advantageous offers. For this reason, to receive assistance under compulsory medical insurance, one should not rely on the use of the latest generation of consumables, everything is chosen the most optimal, effective for providing assistance and recovery.

Documents required

Documents confirming the expediency of performing surgical treatment, including for passing through the CHI program, should directly relate to the patient's personality, medical documents relating to his health. This list includes:

• referral from the attending physician for surgery
• extract from the medical history
• survey results
• analysis data
• passport
• original insurance policy
• SNILS
• checks in case of making any payments (for medicines, examinations)

Do I need to pay extra for services?

As already mentioned, surgical interventions are free. In addition to the work itself, the costs of anesthesia, consumables, and the use of special equipment are covered. If there are requirements for additional payment, it is illegal. Self-financed travel, accommodation, meals outside the hospital. Payment is subject to services that do not belong to the list provided under compulsory medical insurance:

• performing anonymous diagnostics on request (except for HIV)
• diagnostics, procedures in the field of sexual pathology
• speech therapist for adults
• vaccinations, except those related to those provided under compulsory medical insurance
• home visits for the purpose of counseling, diagnosis, treatment, except when a person does not have the physical ability to come to the hospital
• postoperative procedures, which also applies to sanatorium treatment, unless it is included in the OMS
• cosmetology
• psychological support
• prosthetics, except for services covered by compulsory health insurance
• methodological assistance related to patient care

The duty of medical institutions is to inform patients not only about free services, but also about paid ones. It is useful to use price lists, which are posted on special stands in reception areas. When you are admitted to the hospital, you may be informed about opportunities that are available for an additional fee and which may affect your stay in the hospital. To clarify the requirements that are offered, the patient has the right to contact the insurer. This also applies to payment for services and medicines.

In what cases can they refuse and what to do

It is not uncommon for situations to occur when a person is denied free operation. You may also need money for services. In such a situation, people may agree with the statement, but they also have the right to receive written justification for the refusal and familiarize themselves with the established conditions and procedures. At the same time, the patient protects his personal rights as a citizen who has issued an insurance policy. He can contact:

• to the insurer
• to the head physician
• to the district or city health department
• territorial, federal department of compulsory health insurance
• to court

To get a reasoned decision on a complaint, you need to write a written statement in which it is important to state the essence of the problem in detail, clearly, in a business style. It also states:

• Name, position of the person to whom the appeal is made
• Full name, place of residence of the person whose rights were violated
• insurance policy details
• data (details) of the hospital in which the provision of services was denied and in which there is a violation
• the time during which therapeutic measures were carried out, the person was on treatment
• a list of events that led to the unreasonable waste of personal funds and their cost

When filing complaints, evidence is required to confirm the correctness of the applicant. These include extracts from the medical history, payment checks.

Conclusion

The system of assistance to the population has been provided for more than one year, improving every year and providing better services, more quotas. To be served free of charge, it is advisable to consult with your doctor, who will tell you the right decision in an individual case. Do not forget about the possibility of treatment in other regions, since the queue "at home" can lead to complications, and "neighborhood" everything will be done faster, make waiting easier and speed up recovery.

Video: Free prosthetics under the MHI policy

The holder of a compulsory medical insurance policy (CHI) can count on passing all the necessary examinations within the framework of the current insurance program. According to Law No. 323-FZ of November 21, 2011 “On the Basics of Protecting the Health of Citizens in the Russian Federation”, each insured person has the right to receive medical care in a guaranteed amount free of charge in accordance with the terms of the insurance contract. Are all MHI analyzes free of charge and what is included in this list?

Who pays for free tests

Medical care under the CHI policy is free only for its owner. As for hospitals and polyclinics providing outpatient and inpatient treatment to insured persons, each of these medical institutions is obliged to pay the following costs:

• maintenance of special equipment and troubleshooting;
• wages for medical workers;
• purchase of necessary reagents, tools and preparations.

All of the above insurance costs are covered by federal fund compulsory health insurance (FOMS).

Rules for obtaining free analyzes

The receipt of a particular medical service under the CHI policy must be justified. When it becomes necessary to conduct any surveys, you need to proceed as follows:

• visit the clinic along with the compulsory medical insurance policy;
• contact a specialist of the required profile;
• get a referral for free tests.

The patient cannot independently decide which studies need to be done - this is determined by the doctor. All activities that are assigned by a specialist are done free of charge in the same clinic. If the clinic does not have the opportunity to conduct some research, the patient is sent to another medical institution.

On a note! When undergoing a course of treatment in a hospital under the CHI program, the patient has the right to receive all medical services free of charge.

How to get tested in another region

The scope of medical services under the contract compulsory insurance has some territorial restrictions. Outside their region, the insured person receives medical assistance under the terms of the basic program, which operates throughout the country. Within the boundaries of his region, he is served according to a program approved by territorial fund compulsory medical insurance(TFOMS), which covers a wider range of services.

Rules for obtaining medical assistance under compulsory medical insurance in another region:

• during departure, the policy should be with you - it is better to take a picture of it and save the photo on your phone so that you can present it to health workers at least in this form;
• when they refuse to conduct a particular study on a free basis, explaining that this is not provided for by the basic program, you need to look into Art. 35 of the Federal Law No. 326-FZ of November 29, 2010 “On Compulsory Medical Insurance in the Russian Federation” (hereinafter - Federal Law No. 326). If the basic program does not provide for this type of examination, then the refusal is legitimate;
• when a state institution refuses to serve, call the regional TFOMS. The phone number can be found on the website of the Federal Compulsory Health Insurance Fund. It is illegal;
• when health workers claim that they work only with specific insurers, this is also illegal, since the policy is valid throughout the country.

Good to know! Analyzes are a preventive measure, which means an insured event. This is regulated by Art. 3 of the Federal Law No. 326. In accordance with the law, free research to clarify the diagnosis should be carried out throughout the territory of the Russian Federation.

In the event of an incomprehensible situation, call your insurance company - they will tell you how to proceed. The phone number is on the back of the policy.

What tests can be taken for compulsory health insurance for free

The problem is that there is no complete and exhaustive list of free CHI studies. Specialists sometimes do not even know whether a particular study falls under the insurance program. This is due to the fact that the diagnosis of various diseases sometimes requires an individual approach. To make a specific diagnosis, there is no need to puzzle over this issue - just look at the standards medical care.

Remark: the standards of medical care are the selection of minimum effective measures for the diagnosis and treatment of a particular disease.

In order to find out if some type of research is provided for by the CHI program, you must:

1. Look at Article 35 of Federal Law No. 326. For example, if it is necessary to diagnose or observe a disease of the eye and its adnexa (for example, astigmatism), this is included in the CHI program.
2. Next, we are looking for a standard of medical care for this disease on the website of the Ministry of Health of the Russian Federation. We select the subsection “Diseases of the eye and its adnexa” and look for the Order of the Ministry of Health “On approval of the standard for primary health care for astigmatism”. We open it and look for the desired position in the nomenclature list.

An indicative list of standard analyzes for CHI 2020:

You can see a complete list of analyzes for compulsory medical insurance in 2020.

By eco

Approximately one seventh of married couples in the Russian Federation cannot conceive a child through natural insemination. Often this is due to the peculiarities of the physiological structure of the reproductive organs or the banal incompatibility of partners. Fortunately, the state proposes to solve this problem by providing a quota for IVF, which includes both sexes with infertility.

In order to become parents through in vitro fertilization under the CHI program, it is necessary to undergo a medical examination.

List of required list of analyzes for IVF according to CHI 2020:

• general and biochemical analysis of blood and general analysis of urine;
• fluorographic examination;
• blood sampling to determine the Rh factor and group;
• hysteroscopy and pipel biopsy;
• taking smears for the composition of the microflora from the vagina and from the urethra;
• hemostasiogram;
• blood test for homocysteine;
• hormonal panel: study of the level of hormones: prolactin, TSH, T4, in case of menstrual dysfunction - FSH, cortisol (important to exclude the stress factor), estradiol, metanephrine and normetanephrine.
• blood sampling to detect TORCH infections (syphilis, HIV, hepatitis, herpes);
• PCR of vaginal discharge for herpes virus and cytomegalovirus;
• microbiological analysis for chlamydia, mycoplasma, ureaplasma is also included in the compulsory medical insurance policy for IVF;
• smear cytology from the cervix and cervical canal;
• detection of antibodies to the rubella virus;
• Ultrasound of the pelvic organs and the thyroid gland;
• Ultrasound of the mammary glands - up to 35 years, mammography - after 35 years;

Studies for men:

• blood test for TORCH infection;
• spermogram;
• PCR of discharge from the urethra for herpes virus and cytomegalovirus;
• the CHI policy also includes seeding or PCR for chlamydia, ureaplasmosis, mycoplasmosis;
• taking swabs for flora from the urethra;
• blood sampling for Rh factor and group.

The shelf life of the results of the above studies is from 3 months to one year. If there were unsuccessful IVF attempts or interrupted pregnancies before the procedure, partners are advised to undergo a blood test for a karyotype.

Details about and all sorted out in separate articles on our website.

During pregnancy

Expectant mothers also have the right to conduct tests under the compulsory medical insurance policy. To do this, you must be registered in the antenatal clinic and regularly visit your obstetrician-gynecologist.

The list of standard studies includes:

• clinical blood and urine tests;
• blood chemistry;
• allergen tests (in the presence of skin reactions and mucosal reactions)
• research for the detection of infectious diseases;
• detection of antibodies to viral infections - measles and rubella;
• blood sampling for Rh factor and group;
• blood sampling for TORCH infection;
• hormonal panel: hCG, estrogen, progesterone, prolactin.

If the doctor sees the need for any additional studies, they are carried out on a paid basis only when the clinics providing services under the CHI program do not have the appropriate equipment, tools or reagents.

Refund Policy

It happens that the insured person takes a series of tests on his own initiative, so as not to waste time visiting the clinic. Accordingly, payment for the research carried out is made from his own pocket. In such a situation, it is extremely difficult to justify the need to provide free medical services. There is still a chance to return the money spent, but for this you need to do the following:

• keep all receipts for payment for medical services provided on a paid basis;
• bring them to the insurance company and find out if the study falls under CHI program;
• if the tests are included in the list of free tests, you need to write an application for a refund and indicate in it the details of your bank account for a refund.

The above algorithm will take effect only when the patient has a referral from a doctor for paid tests. Otherwise, it is almost impossible to return the spent funds, because the state cannot pay for all studies conducted without a referral, and only on the basis of the insured person's own initiative.

Important! In order to prove your case, first of all you need to know your rights. If a doctor or insurer insists that the required analysis is not included in the CHI program, this can be checked on the website of the territorial MHIF or refer to regulations. Some unscrupulous health workers deliberately send patients for paid tests, and then get their share for it.

Conclusion

Summarizing the above, the following conclusion suggests itself: almost all tests prescribed by a doctor can be carried out free of charge, because there is simply no exhaustive list. The specialist acts in accordance with generally accepted norms and standards - if a certain study is needed to confirm the diagnosis and this is supported legislative act, then this does not go against the terms of the compulsory insurance program.

The patient, in turn, must: know his rights as an insured person, be able to find information of interest in legislative framework and on sites, have a policy with you and decide everything contentious issues with the insurer.

You can learn more about the system and your rights in our next article.

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The Constitution of the Russian Federation guarantees to all citizens free medical care under the policy of compulsory medical insurance (CHI). Types of free assistance provided under the CHI policy:

• primary health care(ambulatory polyclinic);
• emergency,
• specialized medical care(if the diagnosis is established, the specific disease is treated)
• high-tech medical care(treatment of diseases using high-tech, complex, costly methods of treatment).

The presence of a compulsory medical insurance policy confirms that the patient's treatment in public and some private clinics will be paid from the compulsory medical insurance fund, which is formed at the expense of assessed contributions citizens.

Briefly about the CHI system

Payment for treatment in CHI system occurs at specially formed rates for each disease, but does not depend on the method of treatment of this disease. Tariffs are the same for all medical institutions. The compulsory medical insurance tariff specifies how many and what procedures, tests and studies the clinic can and must perform in the treatment of a particular disease.

Tariffs are the same for all clinics, which means that the patient can choose a more high-tech and well-equipped clinic, regardless of the cost of treatment. Mutual settlements with the clinic will Insurance Company.

Some expensive procedures under the CHI system can only be performed if strictly necessary, which the clinic must prove, otherwise they simply will not be paid. CHI fund. Therefore, the treatment of patients in the CHI system, unfortunately, has its limitations.

Medical institutions are forced to work according to the rules established by the CHI fund for each disease. It is important to say that the provision of high-tech medical care (HTMC) to patients, the so-called “quota” treatment, is also paid from the CHI fund and, accordingly, is carried out according to the algorithms prescribed above.

But the tariffs of the VMP system are higher and are intended specifically for the provision of complex, high-tech treatment, which allows the clinic staff to use all their powers. modern ways treatment, advanced technology and high-quality consumables.

Not all hospitals in Russia have the right to provide high-tech medical care. Every year, the Ministry of Health of the Russian Federation compiles a list of clinics that can treat patients according to the VMP. Selected clinics receive a so-called task from the Ministry of Health, which determines the number of patients that the hospital can treat according to the HTMC.

In medical centers of federal significance, only high-tech and specialized medical care is provided under the compulsory medical insurance policy. The Clinic of Coloproctology and Minimally Invasive Surgery is part of the first Moscow State Medical University. Sechenov, respectively, the same requirements apply to her.

How to get medical assistance under the MHI policy?

Option 1. Referral from the clinic

You need the CHI policy itself. If it is not there, and you are a citizen of the Russian Federation, you need to contact the insurance company that works with the territorial CHI fund, write an application and receive it immediately temporary policy, and about a month later, a permanent compulsory medical insurance policy. After receiving the compulsory medical insurance policy, you need to attach to a polyclinic, which you can choose yourself. After that, you can apply for high-tech medical care under the CHI policy.

Referral from the clinic to which the patient is assigned (at the place of residence or at his choice). Such a referral to a city hospital or a federal center is issued to a patient if the doctors of the polyclinic cannot independently diagnose the patient or provide treatment. The referral from the polyclinic allows the federal medical institution, which is the First Moscow State Medical University. Sechenov and our Clinic, to provide the patient with primary, specialized and high-tech care.

In the polyclinic, you can get both a referral for a free consultation at our Clinic, and a referral for free treatment.

Option 2. As directed by the doctors of our Clinic.

Doctors of the Clinic of Coloproctology and Minimally Invasive Surgery can also issue referrals for treatment in some cases. The number of referrals is limited and applies to certain types of diseases or complications.

You can find out about the possibility of free treatment under the CHI policy during an in-person consultation with a doctor. In this case, you will bypass the stage of approval and receiving a referral at the clinic. Please note that referrals for CHI treatment, which are issued directly at our Clinic, have a limited number.

To issue a referral under the CHI policy through the doctor of the KKMC Clinic, you will need:

1. compulsory medical insurance policy
2. self-treatment to the clinic only for treatment (not carrying out a complex of diagnostic measures) with an already established diagnosis