Free medicine: how to use all the possibilities of the compulsory medical insurance policy

OMS policy – a pass to the world of free medicine. This is a working tool that can make the life of its owner much easier. You just need to learn how to use it.

As practice shows, patients rarely begin to assert their rights in the compulsory medical insurance system. In vain. After all, the vast majority of types of medical care can be obtained absolutely free of charge, within the framework of the compulsory health insurance system. Insurance companies can help to understand the CHI system.

It is generally accepted that medical insurance companies are organizations that only issue compulsory medical insurance policies. In fact, insurers have many responsibilities in informing citizens. They also protect the rights of the insured. Therefore, an important right of a citizen is to choose an insurance medical organization, which can be made no more than once a year before November 1.

These are the opportunities provided by the compulsory medical insurance policy.

The compulsory medical insurance policy is a document certifying the right of the insured person to free medical services within the framework of the basic compulsory medical insurance program: from the provision of first aid to high-tech treatment. The insured have the right to receive the bulk of medical care in any region. That is, the necessary medical services under the compulsory medical insurance policy are provided regardless of registration at the place of residence.

Since 2013, a useful addition has been included in the basic CHI program – free medical examination, which can be passed in the clinic at the place of attachment. It allows you to undergo diagnostics without direct medical indications for the earliest possible detection of the most common non-infectious chronic diseases (diabetes mellitus, malignant neoplasms, diseases of the circulatory system, lungs, etc.).

In addition, an expensive in vitro fertilization service (ECO). Since 2014, high-tech medical care (HMP) has been included in the CHI system, its list is expanding every year. Due to the stability of the insurance model, the state has the opportunity to expand the list of types of HMP paid by the CHI system.

Since 2019, for patients with oncological diseases in outpatient treatment, the waiting times for computed (including single-photon emission) and magnetic resonance imaging, as well as angiography have been reduced – no more than 14 days from the date of appointment. Also, the waiting time for specialized medical care for cancer patients has been reduced to 14 calendar days from the moment of receiving a histological examination of the tumor or from the moment of establishing the diagnosis.

Every citizen has the right to choose a medical organization, including on a territorial-district principle, no more than once a year (except for cases of change of residence or place of stay of a citizen). To do this, you must write an application at the selected clinic addressed to the head physician of the medical organization personally or through your representative. An important condition – you need to have a passport, an OMS policy and SNILS (if any) with you.

In the chosen medical organization, the owner of the policy, a citizen can choose a therapist, district doctor, pediatrician, general practitioner or paramedic, but not more often than once a year. To do this, you must submit an application (personally or through your representative) addressed to the head of the medical organization, indicating the reason for replacing the attending physician.

Today, the owner of the compulsory medical insurance policy can get answers to any questions related to the organization of the provision of medical services: whether he is entitled to this or that medical service free of charge under the compulsory medical insurance, how long is allotted to wait for one or another examination, how in practice to use the right to choose a medical institution or a doctor, and etc.

The answers to all these questions are insured in “SOGAZ-Med » can be obtained from the contact center 8-800-100-07-02, which consults and receives complaints from patients who have encountered disorders in the provision of medical care. The center employs qualified insurance representatives.

Since 2016, all insured citizens have the right to consult an insurance representative, who is able to provide broad support to the insured on their issues, and is also obliged to inform patients on various aspects related to their state of health. For example, the duties of insurance representatives, in addition to consulting through the contact center, include:

• accompaniment during preventive measures, that is, medical examination (insurance representatives not only answer specific questions of the insured, but also remind themselves of the need to undergo medical examination at a certain time, visits to doctors based on the results of examinations);

• accompaniment in the organization of planned hospitalization (insurance representatives contribute to timely hospitalization, and also help in the selection of a medical facility that has the ability to receive the patient and provide him with the necessary medical care).

Thus, today the insured have serious guarantees of ensuring their rights to free medical care. The main thing is that patients do not forget their rights and, in case of violations, contact their insurance company.

The insured are entitled to free legal support. If in a polyclinic or hospital they impose paid medical services on you, delay examinations or hospitalization, poor-quality treatment, you can safely address all complaints to your insurance company. In addition to pre-trial protection of the rights of insured citizens, if necessary, SOGAZ-Med lawyers defend the rights of their insured in court.

If you are insured with SOGAZ-Med and you have any questions related to the receipt of medical care in the compulsory medical insurance system or the quality of medical services, please contact SOGAZ-Med by calling the 8-hour contact center phone number 800-100-07-02 −XNUMX (call within Russia is free). Detailed information on the website www.sogaz-med.ru.