By compulsory medical insurance policy you can take tests for free to diagnose and treat most diseases. Forcing a patient to pay for tests in most cases is illegal, but in order to avoid unnecessary expenses or return funds for paying for procedures in public clinics, it is necessary to know the legal basis for the interaction between medical institutions, their patients and the insurance company.

What tests can be taken for free

The procedure for providing citizens with free medical care under compulsory medical insurance policies is regulated by the following regulations:

• Law No. 326;
• Decree No. 1403;
• the laws of the subjects of the Russian Federation.

All citizens of the Russian Federation who have received a compulsory medical insurance policy are guaranteed medical care, both under the basic and additional (regional) programs. The main program includes not only the treatment of pathologies established by the doctor, but also the timely detection of such pathologies, as well as preventive measures.

The list of diseases subject to free therapy throughout the Russian Federation is briefly presented in paragraph 6 of Art. 35 of Law No. 326, and in more detail is given in the List of Section 4 of Decree No. 1403.

Free analyzes are prescribed for the following purposes:

1. treatment of the pathology present in the List;
2. diagnosis of this pathology;
3. diagnosis of possible comorbidities;
4. prevention of suspected pathology and concomitant diseases.

For example, a doctor, based on the symptoms described by the patient, suspects a specific pathology, which is often accompanied by another pathology. If tests for the presence of the underlying disease are free, then tests for the presence of a concomitant disease must also be performed as part of the services paid by the insurance company.

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

Among the main free types of analyzes are the following:

• blood test for syphilis - markers, HIV, and other infections;
  blood and plasma tests for the content of the main elements (red cells);
• biochemical studies of blood and lymph;
• analysis of the content of hormones;
• tissue biopsy;
• high-tech analytical studies of tissues and organs (MRI, CT);
• x-ray studies;
• ultrasound analyzes of tissues and organs;
• scrapings and smears of the skin, foreskin and saliva.

Only expensive tests for suspected rare autoimmune or genetic diseases, which occur less frequently than in 0.01% of cases, as well as aesthetic medicine tests, can be paid.

How to check if analysis is free

To determine the legality of sending a doctor to take paid tests, you need to find out if the necessary analysis is included in the list of services provided under the basic insurance program.

It's important to know that basic list medical services provided throughout the country can be supplemented by:

• regional medical programs;
• employer programs.

Regional programs are budget subventions for paying for services that are not on the All-Russian list, and which are provided free of charge only in a specific subject of the federation. Only patients who are registered in the region and have received an insurance policy from local insurers can receive these services.

In addition, large employers paying insurance premiums for their employees, may provide additional packages of services for free examinations.

To check the possibility to pass the analysis prescribed by the doctor for free, you need to perform the following steps:

1. View the presence of the pathology suspected by the doctor in the main list approved by Resolution No. 1403.
2. In the absence of a disease in this list, find out if it is in the list of services provided by the insurers of the given region or the patient's employer.
3. Find out the list of tests necessary for diagnosis and treatment this disease from the standards on the website of the Ministry of Health.

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

If the diagnosed disease is present in one of the free programs, and the prescribed tests are included in the standard for the treatment of this disease determined by the Ministry of Health, then the patient has the right to take this analysis for free.

How to get a referral

At the initial appointment, the patient is often given a referral for tests to a paid clinic under the pretext that the necessary equipment or reagents are not available in this clinic. It is important to know that only the patient has the right to choose where medical services are provided. The doctor can only issue a referral for analysis, and the place of delivery and processing of the results is determined by the patient.

Getting a referral for free tests is as follows:

1. the patient goes to a specialist doctor to diagnose the disease;
2. the doctor determines which tests the patient needs to pass and issues a referral;
3. if it is not possible to conduct an analysis in this clinic, the doctor issues a referral to another medical institution;
4. if the clinic employee refuses to give a referral for a free analysis, it is necessary to write a complaint addressed to the head or chief physician.

If the appeal to the management of the clinic did not bring results, and the necessary analysis is included in the list of basic or regional services provided under the CHI policy, then the patient should contact the representative of his insurance company.

You can contact using hotline, and personally, to the representative office of this insurer in the locality. Most insurance companies have special departments whose work is aimed at resolving conflicts between medical institutions and patients.

If, after the attempts made, a referral for a free analysis is not received, then you should contact the regional health insurance fund. Such funds monitor the activities of private insurers in the context of respecting the rights of insured patients.

In some cases financial resources, spent by the patient on the delivery of free tests can be returned. You can return funds in 2 ways:

• at the cash desk of the clinic;
• in an insurance company.

If the patient was referred for a paid analysis at the treatment clinic, then to return the funds, you need to do the following:

1. write an application to the head physician for a refund Money;
2. attach to the application a check for payment for tests and an agreement on the medical services provided;
3. receive an order-resolution on the payment of compensation;
4. apply with a copy of the order and a passport to the accounting department of a medical institution.

The application indicates the full name of the patient, his address at the registration and passport data, then you need to state the reasons for the return of funds, indicate the amount spent and the number insurance policy. The basis should indicate the presence of the passed analysis in the basic list of services that holders of compulsory medical insurance policies can apply for.

For a refund, you must keep a receipt for payment for services and an agreement on paid services.

If the patient was sent to a private clinic for testing, the money spent is refunded through the insurer that issued the policy. To do this, you must contact the representative office of the insurance company of the municipality and draw up an application for a refund based on the occurrence insured event- the need to submit an analysis from the basic or additional lists.

Transferring money through insurance company usually within 3-8 business days. If the employer pays the contributions for the CHI policy, then the compensation can be transferred through the cash desk of the enterprise or to a salary card.

Difficult situations

When applying for compensation or when requesting a referral to another medical facility, the patient may experience a refusal or a severe delay in responding to the appeal. In most cases, the situation is resolved by a call to the specialists of the insurance company that issued the policy, or a complaint to the regional MHI fund.

If the prescribed tests are included in the basic list and are an expensive procedure, then the patient has the right to demand the provision of this service free of charge through the judicial authorities. It is important to consider that referral for tests to another locality or a paid clinic can only be issued under the following circumstances:

• the inability to conduct these studies in public clinics of the municipality;
• the absence at the moment of the necessary specialists in the clinic;
• lack of assigned analysis in the basic and additional lists free services;
• application of a person from another region for a service provided within the framework of the program of the subject of the federation.

The doctor must inform the patient about the free equivalent of any medical service provided. Often, patients are deceived by giving a referral for paid tests with the promise of subsequent compensation, to which the patient will not be entitled due to a personal waiver of demons. paid service.

To avoid such deception, you need to carefully review the contract offered for signature when passing paid analyzes for the presence of a clause on the refusal of a free service. In the presence of this item, the money spent can be returned only by a court decision.

If the patient, when providing a paid service, is refused to issue a contract and a check, you need to refuse payment and file a complaint with the head doctor and the insurance company, since these actions of the staff are illegal.

Conclusion

Most of the tests in public clinics can be taken by holders of compulsory health insurance policies free of charge. In order to exercise your rights, you should look for the prescribed analysis in the list of free services and, if necessary, require referral to another medical institution, and in order to return the money spent, it is important to keep a copy of the contract and receipt. Most difficult situations are resolved by contacting representatives of the insurance company.

29.05.17 241 023 10

The doctors were shocked when I showed...

At the weekend I lay at home with an impossible sore throat and a temperature of 39.6.

Throwing not the first dose of paracetamol for the day, I called an ambulance. They told me that it was a sore throat and that I should call the district police officer on Monday. The ambulance didn't come.

Zhenya Ivanova

treated and recovered

I typed in the search bar: "What to do if the ambulance refuses to go." I saw advice on the forum: “Say menacingly that you should call the insurance company now. They'll come right away." I did so. The ambulance arrived. After that, I threatened the doctors twice more with a call to the insurance company and once I actually called the number indicated on the policy. Helped every time.

The insurance company protects my rights and really guarantees free treatment. But if you do not know the laws, then unscrupulous doctors will be able to deceive you, refuse treatment, demand an additional fee.

I recovered and decided to find out what your mandatory health insurance guarantees you.

Get to know your CHI policy

Chances are you already have a compulsory health insurance. It was made for you by your parents right after you were born. It is either in your passport or in a box with all important documents.

If you don't have a policy, drop everything and go to apply

Without a policy, you won't get any free treatment. Fortunately, you can get or exchange a policy in any city without a residence permit and registration. To do this, take your passport and SNILS with you and go to the insurance company that is convenient for you, which issues these policies.

This is a card If there is no SNILS, go first with your passport to the insurance company, then wait 21 days and only then receive the policy.

Citizens of the Russian Federation permanently or temporarily residing in the territory of the Russian Federation can obtain a policy Foreign citizens, refugees and stateless persons. Citizens Russian Federation The policy is issued for an unlimited period of validity. By law, even if you have an old-style policy and it is overdue, insurance will still work. Only until you change your passport details: first name, last name, place of residence.

If you come to the clinic with an old expired policy and you are denied treatment, this is illegal. You must be accepted. In polyclinics, everyone is asked to change policies for new documents, but so far this is only a recommendation. Of course, it is better to heed this recommendation: when a law comes out that terminates old-style policies, it will not take you by surprise.

Which insurance companies provide CHI policies

Compulsory health insurance is an insurance program, that is, everyone pays a little bit into the common pool, and then they pay out of it to those who need it. The common cauldron collects the state from entrepreneurs and distributes it through an extensive system of funds, which, in turn, pay hospitals. And the insurance company is such an intermediary manager that connects you, the hospital and the state.

Insurance companies earn on CHI in the same way as on other services. They are also responsible for the quality of services and discipline in the system. Your first point of contact is the insurance company.

Each region has its own registers of companies that make CHI policies. Just google it.

Where can I get treatment with a CHI policy

To get to a clinic in another city or district, you need:

1. Select a clinic. Any, not necessarily the one closer to home.
2. Find out at the reception which insurance companies work with this clinic. If you have a choice, look at the description of the company on the CMO website. Everyone has the same insurance, but some have more offices, and some have round-the-clock support.
3. Come to the insurance company with a passport and SNILS, fill out an application to replace the policy.
4. Get a temporary license. It works like a policy for a month.
5. Return to the clinic. Say the code phrase “I want to attach to your clinic” at the reception. Get the application form, fill it out and return it to the registry.

Now you can be treated for free in this clinic.

If your insurance company serves the clinic to which you are going to attach, then you do not need to change the policy. But you need to inform the insurance that you have moved and want to be treated elsewhere. Otherwise, money for your treatment new clinic will not receive.

Why you need to join the clinic

You need to join a polyclinic, because our country has a system of per capita financing. Money for your treatment is issued only to the institution to which you are assigned. Therefore, you can not attach to several clinics at once. You can also officially change the clinic no more than once a year. Previously, this could only be done if you moved. In this case, the new clinic will offer you to write an application addressed to the head physician.

You cannot attach yourself to a research institute or a hospital, only to a district polyclinic. And already there, the local therapist will write out referrals to highly specialized specialists: an eye surgeon, a cardiologist, a chiropractor. Without a referral from the attending physician or an ambulance specialist, you can only be admitted to specialized clinics for a fee.

What is EMIA

In Moscow, the data of all patients are entered into EMIAS - a unified medical information and analytical system. This simplifies the process of making an appointment with specialists: you can get a ticket to the doctor, cancel or reschedule an appointment, and receive a written prescription electronically. EMIAS even has mobile app.

Please note: if you have moved and decided to attach to a new clinic, then you cannot just take it and do it through the system. You need to write an application addressed to the head physician and wait until the bureaucracy approves it. This may take 7-10 business days. If you are registered on the Moscow public services portal, then you can apply electronically. It is promised to be reviewed within 3 working days.

When I faced such a problem, I needed help urgently. And by law they are obliged to help me without any many days of delay. But the polyclinic is afraid that if they treat me before the clumsy machine enters new data into EMIAS, then they will not receive money for me from the insurance.

Right in front of the hospital administrator on duty, I called the insurance company, after which I received the necessary consultations at the hospital for free. I was also examined by a whole commission of department heads, and until now everyone treats me very carefully.

What is included in CHI treatment

The law on obligatory medical insurance gives the right to all of us to be treated free of charge. And even if your policy has expired, you can use it.

If you don’t have a policy with you, you can still make an appointment with a doctor, they don’t have the right to refuse you.

Although for nurses this is an additional concern, therefore, most likely, they will try to convince you that it is impossible to do this. If this happens, just call your insurance company.

In any unclear situation, call the insurance

The minimum amount of assistance is described in the basic program of compulsory health insurance. Whether to add something else to this list, each region decides independently. The exact list of insured events can be found in any clinic or found on the website of the Ministry of Health in your region.

In any case, you can apply this rule: if something threatens your life and health, it is treated for free. If you are generally healthy, but want to feel even better, then you can most likely do it just for money. If the state can help you, but the level of this assistance seems too low for you, you will have to accept or pay extra.

Examples of what can and cannot be done under the CHI policy

It is forbidden	Can
Teeth whitening is an aesthetic procedure	Do brushing your teeth because it is the prevention of caries
Get imported Japanese adult diapers by choosing the brand yourself	Get diapers for the elderly
Remove a couple of extra pounds. Your figure is not insured by the state	Remove boil
Wait for exercise therapy exercises from hatha yoga or a modern gym	Go to physical therapy
See a dermatologist if you're just worried about oily skin on your face.	See a dermatologist for severe skin rashes
Make a denture	Remove the tooth

Teeth whitening is an aesthetic procedure

Brushing your teeth, because it is the prevention of caries

Get imported Japanese adult diapers by choosing the brand yourself

Get diapers for the elderly

Remove a couple of extra pounds. Your figure is not insured by the state

Remove boil

Wait for exercise therapy exercises from hatha yoga or a modern gym

Go to physical therapy

See a dermatologist if you're just worried about oily skin on your face.

See a dermatologist for severe skin rashes

Make a denture

Remove the tooth

When something hurts, you can get a free appointment with a therapist who will write a referral to a specialist. When indicated, the GP should issue referrals to any doctors who work in public clinics.

Without a referral, you can make an appointment with a surgeon, gynecologist, dentist and dermatologist at a dermatological and venereal dispensary. Or enroll your child to a child psychiatrist, surgeon, urologist-andrologist or dentist. CHI does not guarantee free tests and examinations without a referral from the attending physician.

Once every three years, you can go through a free medical examination and find out if everything is in order with your health. Medical examination is carried out for everyone every three years - that is, if this year you turn 21, 24, 27 years old and so on.

The CHI program also includes free pain relief and rehabilitation after illnesses and injuries. But it’s impossible to write down once or twice in which case you are entitled to free insurance assistance, and where you have to pay on your own. There are a lot of nuances in this case. If you have a rare disease or a difficult situation, contact the Federal CHI Fund.

What exactly is not included in the CHI program

The state will not pay for:

1. Any treatment without a doctor's prescription.
2. Carrying out surveys and examinations.
3. Treatment at home is optional, not by special indications.
4. Immunizations outside of government programs.
5. Spa treatment, if you are not a sick child or a pensioner.
6. Cosmetic services.
7. Homeopathy and traditional medicine.
8. Dentures.
9. Superior rooms - with special meals, individual care, TV and other joys.
10. Medicines and medical devices, if you are not in a hospital.

If the hospital asks for money for services that are not on this list, just in case, call the insurance company and check if it is legal.

Privileges

People with disabilities, orphans, families with many children, participants in hostilities and other citizens who are entitled to social benefits, the state is ready to pay for more medical services. Each category has its own list of benefits, you can find them in the department social protection or find it on the internet.

Sometimes you are legally entitled to free treatment, but doctors just shrug. There may be a waiting list for free rehabilitation for several months, and painkillers in your district hospital may simply not be available. It's illegal, but it's a fact of life.

Extortion

Doctors are people too, and nothing human is alien to them. Like any person, some doctors are more interested in getting a lot of money from you right now than getting a little less money from the insurance company and much later. Therefore, a whole illegal practice of extorting money for treatment under compulsory medical insurance has grown in Russia.

At the heart of this extortion is legal illiteracy. It is enough for a doctor to make a smart face and take a strict tone so that frightened patients begin to throw money at him. But the slightest sign that the doctor is in front of a legally savvy patient - and the tone changes. Therefore, it is very useful to know what medical services you are required to provide for free.

Remember that treatment is free only for you. The hospital and doctor will receive money for this treatment from the health insurance fund. This money was paid to the fund by entrepreneurs, including your employer.

You do not need to pay a second time out of your own pocket for what the state guarantees you. Moreover, the doctor, most likely, will receive payment from the fund anyway, even if you are forced to pay.

You do not pay for treatment, but the hospital will receive money for it

If you know for sure that you should and can be treated for free, but the doctor offers to pay, call the insurance company. The insurance number is written on your policy, the hotline specialists will help you.

If you cannot do this, ask your doctor to write a written refusal to provide free medical care. If the doctor behaves defiantly, you can turn on the recorder, this is legal. Even if that doesn't work, call the Citizens' Rights Department at CHI system.

7 499 973-31-86 - phone number of the department for the protection of the rights of citizens in the CHI system

Emergency assistance is always free

If something really bad happened - you lost consciousness, broke your leg or feel acute pain - you should be helped in any state clinic, even if you don’t have any documents with you and you never received a policy.

The hospital has no right to refuse assistance to newborns and children under the age of one year, even if the child's parents do not have a policy and registration. They cannot refuse pregnant women either - they can go to any antenatal clinic and any maternity hospital, even without documents.

All participants in the healthcare system are just people: someone's acquaintances, friends, brothers, matchmakers and godfathers. They have parents and children. They are all Russians and they work just like any of us.

• If a surgeon demands a bribe for pain relief, then this is not the healthcare system, it is this particular surgeon, his parents and teachers. It means that his father, somewhere in his childhood, set an example for him that a bribe is normal. How do you feel about bribes?
• If a hospital says it doesn't have money for medicines, it's not Putin's fault, but some officials who don't know how to draw up budgets. Or the head physician who does not know how to manage money. You have a lot of acquaintances who do the same thing at their jobs.
• After all, when you get paid in an envelope, it's your employers who underpay your health insurance. Where will the money for your medicines come from, if you have allowed not to pay for them?

It turns out mild schizophrenia: the same person supports gray salary and complains about insufficient funding for hospitals.

Putin, Navalny, Medvedev, Tinkov or Trump will not solve our health problems. We will solve this problem ourselves if we give our children an example of a conscientious attitude to work and the law. To skip classes at the institute was not a feat, but a shame. It was embarrassing to take tests for money. To give bribes was against our principles. To know and stand up for your rights was a duty, not a superpower.

In short: no one will fly in and give us free medicine as in paid Israeli clinics. All the hell that we see in hospitals is not hospitals, it is ourselves. And me too.

Let's start with paying taxes and contributions. I have everything, thanks. Sorry for the moralizing tone, but I just got tired of this whining.

Remember

1. If you don't have a policy, drop everything and go apply.
2. With a compulsory medical insurance policy, you should be treated free of charge at any state polyclinic throughout Russia.
3. Treatment is free only for you. The hospital and doctor will receive money for this treatment from the health insurance fund.
4. The policy works even if it has expired. If you come to the clinic with an old policy and you are denied treatment, this is illegal.
5. In any unclear situation, call your insurance medical company. The number is on the policy. Write it down on your phone right now.
6. If your insurance doesn't help, call federal fund compulsory health insurance: +7 499 973-31-86.
7. If you spent money on treatment, which should be free by law, write a statement to the insurance company - you should get your money back.
8. Emergency assistance is always free, even if you do not have documents.

27.03.19 121 626 28

Pass all tests, choose a hospital and a doctor

I have been working as a doctor for four years and all this time I hear talk that medicine in Russia has not been free for a long time.

Dmitry Melnikov

In fact, everything is not so bad. There are complex operations that can only be done for money or according to a quota, but most operations are covered by the CHI policy. I’ll tell you, using the example of Moscow, what needs to be done so that you are operated on without money, and what you still have to pay for.

All this applies only to planned treatment, when health problems were identified during the examination. Acute conditions require emergency medical care, and in any case it must be provided free of charge.

medical ethics

In the text, I often use the words “possibly”, “probably”, “for sure” and the like. It's part of my professional upbringing to never make accurate predictions.

Any medical intervention can lead to unpredictable consequences, and a planned one-day hospitalization sometimes turns into a week in a hospital bed. It all depends on the individual characteristics of the patient's body and many other factors. Therefore, we doctors do not say “You will be discharged tomorrow”, but use the wording “Probably, hospitalization will take no more than a couple of days.” This is medical ethics.

What operations are we talking about?

This article will focus on diseases and their treatment - but only as prescribed by a doctor. I understand the desire to google the diagnosis in order to find out more about your condition, but I do not advise you to be treated on the Internet: this can cause irreparable harm to the body.

Treating people is difficult. Before starting to practice, doctors study for at least eight years, and then continue to improve their skills throughout their careers. Therefore, do not trust treatment to anyone other than doctors.

But it is also difficult to be treated, even on the recommendation of a doctor. If the disease is not very disturbing, treatment is often postponed until later. As a doctor, I believe that one should overcome oneself: after all, the stronger the disease is triggered, the more difficult it is to cure it. But as a human being, I know that is easier said than done.

For example, one of my friends after each meal of fatty foods suffers from pain in the right hypochondrium. He was diagnosed with gallstones and treated with surgery to remove the gallbladder. But he is in no hurry: he says that it is difficult and expensive. I can't help it that it's difficult to heal, especially if it means scary. But about the "expensive" acquaintance is wrong: the operation to remove the gallbladder is done under the MHI policy.

In addition to cholelithiasis, hernias, lipomas, and varicose veins are most often operated under compulsory medical insurance, and there are more than two thousand items in the list of free planned operations. A complete list can be downloaded from the website of the Moscow City CHI Fund.

How to make an OMS operation

Choose a hospital

Under the compulsory medical insurance policy, you can be operated on at any state city hospital. You do not have to explain to anyone why you chose a particular institution. It can be a recommendation from friends, the result of a comprehensive study, a sign of higher powers - anything.

Pass tests

All analyzes and studies have an expiration date, and it is not very long. For example, for a general and biochemical blood test, this is only two weeks. If you donated blood before, then the results of the analysis are no longer informative enough. And it is important for the surgeon to know what is happening with your body right now. Therefore, you will be asked to retake everything: all of a sudden, any surgical intervention is already contraindicated for you.

The list of studies is almost the same everywhere - these are blood and urine tests, ECG, fluorography and ultrasound. If there are chronic diseases, the list can be expanded. For example, if a person has problems with the thyroid gland, he will be asked to do an analysis to determine the levels of thyroid hormones, and in case of bronchial asthma, they will undergo functional tests.

The results of tests and studies must be brought to the doctor who will perform the operation. If everything is in order, he will tell you the date when you need to go to the hospital. In case of any problems, the surgeon can send for a consultation to another specialist. For example, if the cardiogram shows an arrhythmia, you will have to go to the cardiologist and he will already decide whether this will interfere with the operation. Sometimes the risk is too great. If the patient has a small hernia, but there are problems with the lungs and metabolism, then it is better to be like a hernia than to undergo surgery with unpredictable consequences.

Free tests can be taken at the clinic where they issued the referral. But here, how lucky. It happens that the tests are done quickly, but it happens that “ECG is only on Wednesdays and Fridays, and the radiologist will return from vacation in two weeks.”

If you do not want to wait, you can contact any commercial medical center. Ultrasound, cardiogram and fluorography will be issued on the same day, and the results of the tests - in a maximum of two days. There you can also get advice from the right specialist if for some reason you can’t get an appointment with him. free line. This will add another one and a half to two thousand rubles to the check.

Average prices of Moscow centers for examinations before surgery

Ultrasound of the veins of the lower extremities

4000 R

Blood chemistry

3000 R

Gallbladder ultrasound

1800 R

Chest x-ray

1800 R

Blood test for carriers of infections

1790 R

Coagulogram

1720 R

1500 R

General blood analysis

800 R

Get to the hospital

On the day appointed by the doctor, you will have to appear at the admission department of the hospital. You must have a passport and a policy with you, the results of analyzes and consultations, as well as a referral from the clinic, signed by the head of the department. In addition, I advise you to take a change of clothes and hygiene items: not after every operation you can go home the same evening.

The admissions department will take a medical history. This is the main document where everything that will happen to you in the hospital will be recorded: information about studies, the protocol of the operation, diaries of the daily condition.

A medical history is not the same as a medical record. The medical record is kept constantly, it contains all the information about a person's health. And a medical history is taken for each hospitalization. After discharge, it is handed over to the archive, and the patient receives a short version of the document - the discharge summary.

After completing the documents, the nurse will take you to the department and put you in the ward.

Chambers are free and paid. Free rooms in specialized departments of hospitals, usually for 3-6 people, with a bathroom and shower. Paid chambers are designed for one or two people. There is always a fresh repair, TV, even Wi-Fi. Prices in Moscow hospitals start at 2,000 rubles - a day in a double room.

width="2000" height="1826" class=" outline-bordered" style="max-width: 1000.0px; height: auto" data-bordered="true"> VIP ward in the Moscow City Hospital No. 31 for 14,900 R per day

Survive the operation

Most often, the operation takes place on the day of hospitalization: in the morning a person comes to the hospital, and a few hours later he is operated on. The duration of the planned operation depends on the disease. Say, with cholelithiasis it is 40-60 minutes, and with a serious hernia - several hours. After the operation, if everything goes according to plan, the patient returns to the ward.

Endoscopic surgery and modern methods recovery helps to ensure that during the operation the body is minimally harmed, and after it it quickly returns to normal. Therefore, after a simple operation, such as removal of the gallbladder or lipoma, you can be discharged on the same day - as soon as you recover from anesthesia. As my experience shows, when a person feels healthy, they do not detain him in the hospital.

I have heard stories of patients being discharged from the hospital before they have had time to recover. In my experience, a doctor will not discharge a person unless they think they are healthy. If this does happen, you can complain about the doctor to the Ministry of Health and he will answer for his negligence. Hospitals are now required to respond to all complaints and comments, even on social media.

But I would like to remind you that the patient and the doctor are on the same side and the ostentatious separation between the client and the provider only harms the treatment process. Medicine has not yet reached such a level that the doctor can always guarantee a certain result of treatment or the absence of complications.

If you feel unwell or think that the doctor did something wrong, it is better to try talking to him personally first and explain everything. Perhaps there is no need to complain.

check out

Before you are sent home, you will be given a discharge summary in your hands - this is a copy of the medical history, which records everything that was done to you in the hospital. It will also include doctor's recommendations. For several weeks after the operation, you can not lift weights, sometimes you need to follow a special diet. Even the simplest operation is still a great stress for the body, and for some time after it it is weakened. If you ignore the advice of a doctor, there is a risk of ending up in the hospital again.

If you are officially employed, you will be discharged with an open sick leave "for outpatient follow-up care." You need to come with him to the surgeon who issued the referral for the operation, or to any other outpatient surgeon on duty. The doctor will assess your condition and, if necessary, extend the sick leave: you have every right not to go to work until you recover.

Many hospitals use special cosmetic sutures made of special threads, which dissolve themselves a few days after the operation. But if the stitches are normal, it will be necessary to periodically do the dressing. For this, it is not necessary to go to the hospital, everything can be done in your clinic.

Remember

1. A planned operation can be done free of charge under the policy compulsory medical insurance.
2. The patient has the right to choose the hospital and the doctor who will perform the operation.
3. Without a referral, the operation will not be performed. It is issued by a doctor in the clinic to which you are attached.
4. If the operation is simple, you may be discharged on the day of the operation. This is fine.
5. A sick leave for work is issued at the hospital where the operation was performed, and the doctor in your clinic closes it.

Worked on the material

Author - Dmitry Melnikov, editor - Petr Ryabikov, production editor - Marina Safonova, photo editor - Maxim Koposov, information designer - Zhenya Sofronov, illustrator - Karina Golubenko, editor - Anna Lesnykh, proofreader - Alexander Salita, layout designer - Evgenia Izotova

Which medical services free, what do you have to pay for? Why do I need a health insurance policy and how to get it? How to attach to the clinic and how long to wait for an appointment with a specialist? Why can you be denied an ambulance call and where to complain if you are faced with rudeness or negligence of doctors?

Free Services and Medicines

The right to free medical care is guaranteed by Article 41 of the Constitution of the Russian Federation. But what is included in the concept of "free medicine" if in practice you have to pay for a lot?

By law, patients are entitled to the following free medical services:

• emergency help ( ambulance)


• outpatient care in the polyclinic (examinations and treatment)


• inpatient medical care:

1. - abortion, pregnancy and childbirth


2. - in case of exacerbation of chronic and acute diseases, poisoning, injuries requiring intensive care or round-the-clock medical supervision


3. - planned hospitalization

• high-tech medical care, including the use of complex and unique methods of treatment, new technologies and equipment


• medical care for people with incurable diseases.

A complete list of cases in which you are entitled to free medical care is included in the basic program of compulsory health insurance. To check this list, you can contact your insurance company (you can find the company's phone number on your policy).

Please note that you are also entitled to free medicines if your condition is rare, life-shortening, or disabling. The list of vital and essential drugs is approved by the state and spelled out in the text of the law.

You will have to pay for other services and medicines.

Medical policy

A compulsory medical insurance policy (OMS policy) is a document that allows a person to receive free medical care in hospitals and clinics throughout the Russian Federation. It is issued by insurance companies that are licensed to work in this area. The insurance company that issued you the CHI policy pays for medical services and protects your interests in conflicts with medical institutions. Keep in mind that in order to receive legally free medical services, you must have a policy with you. Without presenting it, only emergency assistance is provided. Anyone who is on the territory of the Russian Federation, including foreigners and refugees, can receive a CHI policy.

How to get an OMS policy?

To do this, you need to contact an insurance company that has the appropriate license. The official rating of insurance medical organizations will help in its choice. Over time, you can change the insurer if you are dissatisfied with the quality of his work. Remember that by law this can be done no more than once a year and no later than November 1st.

What documents are needed to apply for an OMS policy?

For a citizen of the Russian Federation under 14 years of age,:

• birth certificate


• passport of the legal representative (for example, one of the parents)


• SNILS (if available).

For a citizen of the Russian Federation over 14 years of age,:

• passport of a citizen of the Russian Federation


• SNILS (if available).

What is the validity period of the MHI policy?

For citizens of the Russian Federation, the policy is unlimited, temporary policy is done for refugees and foreigners temporarily residing on the territory of the Russian Federation.

In what cases can the CHI policy be replaced with a new one?

Despite the fact that the policy is indefinite, it can be replaced with a new one.:

• with a planned change of the CHI policy (for example, with the introduction of a new sample)


• when changing residence within the Russian Federation, if the insurer does not have a representative office at the new place of residence


• when inaccuracies or errors are found in the policy


• when the policy is dilapidated, which creates an identification problem


• in case of loss of the policy


• when changing the personal data of the policy holder (full name, passport data, place of residence).

Polyclinic

Upon receipt of the compulsory medical insurance policy, a polyclinic is selected to which you will seek medical help (that is, you are “attached” to it). You have the right to choose any clinic that will be convenient for you to visit (closer to home, work, summer cottage). The only condition is that she must be able to accept a new patient (the planned load is determined by the standards).

How to join the clinic?

Your attachment to the polyclinic at the place of residence occurred automatically if:

• you live at the same registration as when you received the policy


• you live at the same address that you mentioned when you received the policy (even if it is different from the registration).

For self-attachment, you will need to write an application to the administration of the clinic. Keep in mind that if you are attached to a polyclinic not at your place of residence, then you will not be able to call a doctor at home.

Remember that according to the law, you can change the clinic no more than once a year, with the exception of cases of changing the place of residence or stay.

What documents are required to attach to the clinic?

List of documents for a child under 14 years old:

• CHI policy (original and copy)


• birth certificate


• identity document of the legal representative of the child (for example, a parent)


• SNILS (if available).

List of documents for citizens over 14 years old:

• application addressed to the head physician of a medical organization


• CHI policy (original and copy)


• passport of a citizen of the Russian Federation


• SNILS (if available).

Can you be denied attachment to a polyclinic and why?

They can refuse to attach if the selected polyclinic is overcrowded and is not located in your area of ​​​​residence. You have the right to demand a written refusal, on the basis of which you can complain to the insurance company, the Ministry of Health or Roszdravnadzor.

Doctor's appointment. How to get there and how long will you have to wait?

You can make an appointment with a doctor (get an appointment coupon) in person through the registry of a medical organization or remotely through an electronic registry (if available). But doing this is often quite difficult. The next appointment with doctors can be only in a few months or not at all (“no coupons”). How long can you wait according to the law, and what to do if you are not provided with a service on time?

Each region independently sets the waiting time for medical care in its territory. You can obtain information about the terms in force in your region from the territorial compulsory health insurance fund or from your insurance company (you will find the company's telephone number in your CHI policy).

As an example, let us cite the deadlines set in Moscow. According to the decree of the Government of Moscow, the maximum terms are set:

• initial appointment with a local therapist, a local pediatrician and a doctor general practice(family doctor) occurs on the day of treatment;


• for appointments with specialist doctors - up to 7 working days;


• the urgency of laboratory and instrumental studies is determined by a specialist doctor, the waiting period should not exceed 7 working days. An exception is angiography, computed tomography and magnetic resonance imaging, the waiting period for which can be up to 20 working days;

If the medical organization cannot meet the specified deadlines, there is no necessary specialist or equipment, then by law the patient must be sent to the nearest medical institution for diagnostics, and absolutely free of charge. If these provisions are violated, you may file a complaint with medical organization to your insurance company or to other agencies that we talk about in the "Where to complain?" section.

Is it possible to change the attending physician and how?

Yes, according to the law, you can change not only the medical organization, but also the attending physician (district doctor, general practitioner, pediatrician, general practitioner and paramedic). To do this, you need to apply to the head of the medical institution. You can change a doctor no more than once a year, except in cases of a change in place of residence or stay.

Emergency

TO free medicine also applies to emergency services. Everyone on the territory of the Russian Federation can use it, including those who do not have a compulsory medical insurance policy. Many complain about the waiting time for an ambulance, but not everyone knows that the arrival time of the medical team primarily depends on its type, their two:

• ambulance service. She goes to emergency calls if there is a threat to the patient's life: injuries, accidents, acute illnesses, poisoning, burns, and others. According to the standard, this assistance must arrive at the patient within 20 minutes;


• urgent Care. It deals with the same cases as an ambulance, but only in the absence of a threat to the life of the patient. This help must arrive within two hours.

It is up to the dispatcher to decide what type of assistance to send to you.

How to call an ambulance?

We all remember the memorized truth from childhood that to call an ambulance it is enough to call the number "03". Landline telephones eventually become a thing of the past, they are replaced by mobile communications. Almost everyone has a mobile phone at hand, but not everyone knows how to call an ambulance from it.

You can call an ambulance by calling:

• 03 from a landline


• 103 s mobile phone


• 112 from a mobile phone (single emergency number).

Number 112 is universal. By this number you can call the fire brigade, police, ambulance, emergency gas service, rescuers. You can call this number even with a zero balance, a blocked SIM card, or if it is not in your phone. However, this service does not work in all regions of the Russian Federation today.

When will an ambulance arrive?:

• in acute diseases that have arisen at home, on the street or in a public place;


• during catastrophes and mass disasters;


• in case of accidents: burns, injuries, frostbite and others;


• in case of sudden diseases that threaten human life: disruption of the cardiovascular and nervous systems, respiratory organs, abdominal cavity, and so on;


• during childbirth and violation of the course of pregnancy;


• for any reason to children under 1 year old;


• to neuropsychiatric patients with acute mental disorders that threaten the safety of others.

In which case the ambulance will not arrive:

• when the patient's condition worsens, which is observed by the district doctor;


• when calling to patients with alcoholism to relieve a hangover syndrome;


• to provide dental care;


• for the provision of medical procedures prescribed in the order of planned treatment (dressings, injections, etc.);


• for issuance sick leave, recipes and references;


• for the issuance of forensic and expert opinions;


• for drawing up an act of death and examination of the corpse;


• to transport patients from hospital to hospital or home.

What is the duty of an ambulance?

The arriving team will provide emergency medical care and, if necessary, hospitalize you in the hospital. The doctors of the brigade can give verbal recommendations for treatment, but they do not write out certificates and sick leave.

Where can I complain about my doctor?

There are times when a conflict arises between you and your doctor. What to do in such a situation? Complain.

1. The easiest way to complain is to write a statement addressed to the head physician. This will help resolve the issue locally.


2. If you have complaints about the quality of service in a medical institution or you are offered to pay for medical services that are free by law, you can contact your insurance company.


3. If you are unable to resolve the problem at the local level, then you can contact the Ministry of Health. You can file a complaint in person at the ministry’s reception, send it to the regular postal or e-mail address of the department, and also leave an appeal on the official website.


4. If your problem has not been resolved by the Ministry of Health, then you can contact Roszdravnadzor, which controls the healthcare sector. The application can be left on the website of the department, sent by regular or e-mail.


5. If the previous actions did not lead to the desired result, then you can contact the prosecutor's office. She will check the work of state institutions.


6. If the conflict still has not been resolved by the indicated methods, then you can go to court. In the claim, it is necessary to indicate the essence of the case, explain what rights were violated (with references to the relevant articles of the laws), attach documents proving the defendant's guilt.


7. Contacting the police is appropriate if the doctor intentionally harmed your health, threatened, extorted or insulted your honor and dignity.

Keep in mind that the period for consideration of applications in each case, according to the law, is 30 calendar days.

The Constitution of the Russian Federation guarantees to all citizens free medical care under the policy of compulsory medical insurance (CHI). Kinds free help 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 the compulsory medical insurance 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. IN compulsory medical insurance tariff it is prescribed how many and what procedures, analyzes 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 be carried out by the 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 the power of modern treatment methods, advanced technologies 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 an insurance company that works with territorial fund CHI, write an application and immediately receive a temporary policy, and about a month later, a permanent CHI 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