Medical fees

Doctors may not claim payment for:

• ordering a patient for examination, including a specific time order,
• writing out the recipe or medical certificate,
• writing out a proposal for spa treatment,
• confirmation of the visit of a doctor or other healthcare professional,
• exchange note to specialist,
• priority treatment.

Patients do not pay for air conditioning in the waiting room or for sanitary swabs.

Doctors may claim reimbursement for:

performances not covered by public health insurance, e.g. for medical certificates for driving a motor vehicle or for an arms passport.

Price list:

• control the VÚC,
• the proceeds of the fines will be the revenue of the respective self-governing region,
• the amount of fees shall be fixed by the doctor, the price list being placed in a prominent position in the waiting room,
• the proof of payment of the fee must be a precise specification of the fee from the price list.

What does the patients care about?

• Can an allergologist ask 5 Eur for a card to another doctor - an allergologist?
  The contractual healthcare provider may not claim reimbursement for such an act, as it is neither the provision of health care nor the service related to the provision of healthcare. A non-contractual healthcare provider cannot make such reimbursement conditional on the provision of healthcare. It is noted that a specialist does not generally issue his medical documentation, but prepares a medical report to the patient.
• Can you explain to me what the term "annual registration fee" means, namely EUR 20?
  The annual registration fee shall not be the provision of health care, nor the service related to the provision of health care and the contractual healthcare provider may not require the payment of such a fee. The healthcare provider cannot make such reimbursement or make the provision of healthcare conditional.
• When we arrived for the check-out, the doctor sent us home that she barely prosecuted patients ordered - paying (for the management of the patient) who had ordered for each day already 5-6 weeks in advance. All that has changed is that he no longer writes on the proof of payment of the priority order's order, but the patient's professional management, which nobody can explain for what it is... Will MZ SR explain this to me?
  The professional management of the patient is neither a health service nor a health care service. A healthcare provider should not collect reimbursement for such action. The healthcare provider may not claim reimbursement for the priority provision of healthcare within the indicated hours of surgery intended for the preferred provision of healthcare.
• Do I have to pay a fee for taking blood from my doctor when it comes to pre-operative examination?
  Where blood collection is indicated for health reasons, the contractual healthcare provider may not claim payment from the insured person for such performance.
• I paid $7.50 for the xg teeth for the CD fee. I didn't see a price list anywhere in the office where it was written for what they charge. Is such a fee okay?
  As regards non-contractual services, it is the patient's full right to decide whether he will go to another healthcare provider to which such services are reimbursed by the health insurance undertaking or to make voluntary use of the option offered by the provider outside the health insurance system (it will be agreed with him to carry out a certain examination and pay him a price in the sense of the provider's price list). In this case, however, it is not a request for reimbursement, but a voluntary payment on the basis of an agreement between the doctor and the patient. However, it must always be the choice the patient chooses, and the doctor must not make further provision of health care conditional upon carrying out such paid performance with him. However, the insured person must have sufficient information that he can receive this healthcare from health insurance. Persons obliged to take part in public health insurance must pay health insurance and be entitled to free healthcare to the extent provided for by law, which is fully in accordance with Article 40 of the Constitution of the Slovak Republic.
• Why will doctors continue to be able to charge charges, e.g. for a medical certificate?
  Since this is not the case with healthcare provided by the health indication, healthcare providers will be able to claim reimbursement for such actions. The issue of a medical certificate is preceded by certain health performances, not the kind of certificate that is part of the health performance, such as a medical visit.
• What about the possibility of voluntary payment in CRP examination? According to the law, this is not possible and doctors fear that it will be abused against them.
  If the CRP is directed by a doctor, it is covered by public health insurance under a contract between the health insurance company and the health care provider. If, at the patient's own request, it is not indicated by the doctor, the patient agrees to perform the examination and any payment in terms of the price list is considered to be a voluntary payment based on an agreement such as the patient's written consent.
• I don't understand what you've done. After all, the charges will continue to be set as they wish, and thus will remain inconsistent. You should have imposed a charge on the upper limits so that the counties could compare them. For example, dental practice does not even need to indicate how they arrived at the specified amount. How are you going to deal with this?
  The health performances provided for the disease listed in the list of diseases and the health care services provided by the provider and for which he may claim reimbursement shall be controlled by a higher territorial unit competent for the place of operation of the medical facility by carrying out surveillance under a specific regulation. As regards the setting of the maximum price of the so-called "price cap"" we must note that the Ministry of Health of the Slovak Republic does not specify the level of fees due to the price law.
• Please answer my question: The physician pneumologist will write me a proposal for spa treatment at the lung clinic - am I paying a fee for his writing, which was EUR 15.00 in the past? Or is it the decision of the hospital manager?
  Issuing a proposal for spa treatment is part of the health performance, i.e. the healthcare provider cannot claim reimbursement for it.
• In April I ordered sonography and mammography. The order works there by making a phone call to the reception, and the worker on the phone sets a date for the examination. Then the woman said that I should prepare 7 euros in addition to the doctor's recommendation. Does he have the right to ask me for this fee?
  In order to order a patient, this is part of the health performance, i.e. the provider may not claim reimbursement for such performance from 1.4.2015.
• Today, I was on my exam at the gradient orthopedist, who asked me at the end of the examination for FIRST-EARING EUR 5. I mean, there's no such warning in the waiting room or the office door! Is it possible for him to claim such an amount for the FIRST INVESTIGATION?
  In the case of a contract physician, the examination is covered by public health insurance, that is to say, the provider cannot make such reimbursement or make the provision of health care conditional.
• What about fees for PN or ČER?
  The patient in the practice is not eligible for PN or CR. Health benefits for social insurance purposes (within the meaning of Section 156 of the Social Insurance Act) are paid directly to the healthcare provider. It follows from the above that the healthcare provider has no reason to claim payment for the health services in question from the insured person, but directly from the Social Insurance Institution.

What interests healthcare providers (doctors and hospitals)?

• What will be the procedure for applying for preference not for health reasons, but for example for social or occupational reasons, so that it does not discriminate against other patients?
  The legislation does not specify how the healthcare provider should manage the ordering of the patient for examination. Law No 577/2004 Z. z. states that part of the health performance is the ordering of the insured person for examination, including ordering for a specific time.
• What about the price list (s) for which the provider may claim payment?
  The price list for all health performances and the list of health performances and services for which reimbursement may be claimed are 2 different things which cannot be confused. The list is a zero, the price list is in this form almost 2 years, only an explicit obligation to comply with it has been added and sent (including changes) VÚC:
  § 102r (1) of Law No 578/2004 From:
  Transitional provisions on adjustments effective from 1 April 2015
  (1) By 31 May 2015 at the latest, the Provider is liable to send to the Municipality appropriate to the place of operation of the medical facility price list of all health performances Under § 79 para. 1 letter (g) a List of health services for which reimbursement may be requested Under § 79 para. 1 letter (effective as of 1 April 2015)
  Paragraph 79 (1) of Law No 578/2004 From:
  (1) Providerholding a permit or licence to carry out a separate medical practice; is mandatory, unless otherwise provided for in paragraph 3;
  (g) Place in an accessible and visible place price list of all health performances provided by the provider; the display of the price list at the entrance, the waiting room or other publicly accessible premises of the medical facility and the publication on the website of the provider, if established (effective from 1 October 2013), shall be considered an accessible and visible place.
  (zu) respect price list all health services which must be sent without delay and demonstrably, including any change thereto, to the self-governing region responsible for the place of operation of the medical facility (effective as of 1 April 2015)
  (zv) Place in an accessible and visible place at entry or a waiting room, a list of the health performances provided for the disease listed in the list of diseases where health performances are fully or partially reimbursed or not reimbursed on the basis of public health insurance and the health care services provided by the provider and for which it may claim reimbursement under specific regulations55jah) (hereinafter referred to as "List of health services for which reimbursement may be requested") in the case of a provider with which the health insurance undertaking has a contract under a special regulation (effectiveness from 1 June 2015).
  (zw) comply with the list of health services and services for which reimbursement may be requested, which must be sent without delay and demonstrably, including any change thereto, to the self-governing region responsible for the place of operation of the medical facility, in the case of the provider with which the health insurance undertaking has a contract under a special regulation (effectiveness from 1 June 2015)
• My question concerns two charges: although the CRP is partially paid by insurance companies, each with a different amount, but the actual amount for examination, material, purchase and amortisation of the apparatus, chemicals and accessories required for examination and regular inspection and calibration of the apparatus is higher. Is it possible to collect the relevant premium, according to individual insurance companies with regard to their payment, to continue? Of course, under the conditions of transparent accounting and payment records. A similar problem is Strep And a test to determine the presence of Streptococcus pyogenes in the goal of the pharynx, which makes a major decision on the selected therapy.
  According to the order No. 44/2008 Coll. on minimum requirements for personal security and material and technical equipment of individual types of medical devices, the apparatus for examination of CRP is another material technical equipment of general office for adults and general offices for children and adolescents.
  In view of this, we foresee an existing contract between the provider of outpatient healthcare and the health insurance company.
  If a CRP examination is administered by a doctor, the costs of this examination shall be reimbursed by the patient's health insurance company. It is for consideration to recalculate the costs of the examination with the provider and compare them with the payments of the health insurance company and, in the case of disrepair, address health insurance companies. If a CRP is performed at the patient's own request, i.e. if it is not indicated by the doctor, the patient agrees to perform the examination and any payment in terms of the price list is considered to be a voluntary payment on the basis of an agreement, such as the written consent of the patient recorded in the medical documentation.
  On the contrary, Strep And the test is not one of the material technical equipment of the general doctor's office within the meaning of the aforementioned decree.
  We therefore recommend to contact health insurance companies and ask for a contract for such an examination. If the health insurance company does not conclude the contract and therefore the examination is not covered by public health insurance, a fee may be charged for this examination. However, the physician should instruct the patient or his legal representative in advance and make a medical record of the patient's application. The amount of the fee must be included in the price list published in the accessible place.

What is interested in self-governing regions?

• Is the fee for the provision of the doctor's mobile number or the premium for the above-standard, a transaction for which health insurance legislation would allow for the collection of the payment?
  1. VÚC has no competence to approve a price list or a list of paid health performances. (Art. 44 (3) of Law No 577/2004) The Z. z. z. reads: "Provider with whom the insured person's health insurance company has a contract under a special regulation30) may require the insured person to be reimbursed for medical care provided in the case of an illness listed in the list of diseases, at the maximum amount of the insured person's participation under this law and the rules issued for its implementation. The Provider may require payment from the policyholder for services related to the provision of healthcare36) at the most in the amount of the insured person's participation under this Act and the rules issued for its implementation. The health performances provided for the disease listed in the list of diseases and the health care services provided by the provider and for which he may claim reimbursement shall be controlled by a higher territorial unit competent for the place of operation of the medical facility by carrying out surveillance under a specific regulation. If the self-governing region finds a breach of Article 44 of Law No 577/2004 in its control activities Z. z., can impose a fine on the provider up to 16 596 Euro.
  2. If the county of self-governing finds out that the legislation has not been complied with in the notified list, it may, in the course of its supervision with the provider, carry out an inspection to ensure that the correction is carried out. The health care provider derives from Paragraph 79 (1) (a). zv) of Law No 578/2004 the obligation to place in an accessible and visible place at the entrance or the waiting places a list of health performances provided for the disease listed in the list of diseases where health performances are fully paid or partially paid or not paid on the basis of public health insurance, and the health care services provided by the provider and for which it may request reimbursement under specific rules, in so far as it is the provider with which the health insurance undertaking has a contract under a specific regulation. For breach of this obligation, the self-governing region can impose a fine up to EUR 3319. Fines can be imposed repeatedly.
  3. The fee for the provision of a mobile doctor's number, the premium for the above standard, is not an act for which health insurance legislation would allow for the collection of the payment. As regards health performances for which the legislation allows the collection of reimbursements (e.g. driving licence), their amount is not regulated by the municipality.

• In the case of a high number of healthcare providers in each self-governing region, it is necessary to set a time limit for the approval of the list of health performances provided for the treatment of the disease listed in the list of diseases, health care and performance-related services which are neither a health performance nor a health care service for which the provider can claim payment. What will be the time limit for the approval of that list?
  Local authorities will not approve health care providers' lists of health performances and services for which reimbursement may be required, or all health performance price lists. Providers have only an obligation vis-à-vis self-governing regions to send a list and price list as well as their changes. They shall do so for the first time by 31 May 2015 at the latest.
• The price list approval agenda is time-consuming, moreover, there are no maximum prices or performances for which the provider requests a fee from the patient. For example, the patient management fee is not defined, yet providers often mention it in their price lists. How should self-governing regions proceed?
  The legislation does not provide how the healthcare provider should manage the ordering of the patient for examination. Law No 577/2004 The Z. z. provides that the health performance includes ordering the insured person for examination, including ordering for a specific time.
  The healthcare provider cannot make such reimbursement conditional on the provision of healthcare.
• Until now, healthcare providers have collected fees in addition to so-called management fees, e.g. a patient fee for air-conditioned waiting rooms, given that no legislation excluded the collection of these fees. What will be the subject of the approved price list now?
  Contracting health care provider may require reimbursement for medical care provided in the case of a disease listed in the list of diseases at the maximum amount of participation of the insured person pursuant to Act No. 577/2004 Coll. and Government Decree No. 777/2004 Z. z. The service related to the provision of health care can only be what was laid down by § 13 of the Act No. 576/2004 Coll. and the health care provider can claim payment for them at the most in the amount of participation of the insured person pursuant to Act No. 577/2004 Coll. and Government Decree No. 722/2004 Z. z. z.
  The patient's payment for the -air-conditioned waiting room and similar -fees-- cannot be required.