Affiliate material
In this case, insurance representatives are needed, and here’s what they help.
A patient came to polyclinic N and, having contacted the registry, unfortunately, did not receive exact answers to the questions asked. The queue for an appointment with a therapist turned out to be too long, and there was no doctor of the narrow specialty he needed in the polyclinic at all. But the patient did not become nervous and scold the doctors, but called his medical insurance company, which issued him a compulsory medical insurance policy, and asked for help. The contact center of the company accepted the request of the insured. As a result, it was insurance representatives who helped find a solution to the problem.
Who are these medical guards who know the methods of solving all issues, and why are insurance representatives so necessary for patients? Can anyone become an insurance representative or does this activity require some training? Answers to numerous questions were provided by the employees of one of the largest Russian medical insurance organization SOGAZ-Med.
Sergey Ivanovich Zaitsev, Deputy Executive Director of SOGAZ-Med for the Protection of the Rights of the Insured:
– In 2016, a nationwide project was launched in the Russian Federation to create an institute of insurance representatives, then insurance representatives of the 1st level began to work. Since January 2017, the activities of representatives of the 2nd level began. From January 1, 2018, insurance representatives of the 3rd level began to function. Most often, caring people who seek to help others come to the work of insurance representatives. These employees work not only in contact centers of insurance companies, but also advise patients in clinics. Insurance representatives of all levels must have a high level of literacy and stress resistance.
I would like to dwell on the insurance representatives of the 3rd level in more detail. They can only be employees with a higher medical education, work experience in a medical specialty for at least 5 years, trained in specialized universities on the topic “Expert activity in the compulsory health insurance system” and qualifications under the program “Training of third-level insurance representatives in the field of compulsory health insurance “.
Now the SOGAZ-Med company employs more than 220 insurance representatives of the 3rd level who have undergone special training. The main purpose of the activities of these employees is to help and advise the insured in the most difficult moments, to work with written requests from insured persons (complaints regarding the provision of medical care) requiring a qualified approach.
At SOGAZ-Med, the duties of insurance representatives of the 3rd level are performed by expert doctors with many years of experience, knowledge of the legal framework and extensive professional experience. For example, an insurance representative of the 3rd level, Honored Doctor of the Russian Federation Igor Romanovsky. In practical medicine since 1981. After graduating from the Military Medical Faculty, he served in the Armed Forces of the USSR and the Russian Federation as an infectious disease doctor. For more than 20 years he served in the Ministry of Internal Affairs of Russia, rose from a medical inspector to the head of the Center for Medical Directorate of the Ministry of Internal Affairs of Russia. Retired Colonel. War veteran. In 2009, Igor Leonidovich was awarded the honorary title “Honored Doctor of the Russian Federation” for his great contribution to the development of departmental medicine by the President of the Russian Federation. In October 2016, he began working at the SOGAZ-Med insurance company as a specialist doctor.
– I would like to note that not every doctor can be an insurance representative, but every insurance representative of the 3rd level must be a doctor with work experience. Hence, we can conclude that insurance representatives of the 3rd level are the most competent specialists in the field of compulsory medical insurance, – says Igor Romanovsky.
The institute of insurance representatives is very young. However, it is already clear that citizens need it. An insurance representative of the 3rd level in the process of work has not only to carry out examinations, but also to answer many other questions related to medicine, legal requirements. Work in practical medicine and professional experience allow us to actively help patients in protecting their rights to receive quality medical care in the compulsory medical insurance system.
Thus, the patient is always ready to help the specialists of his insurance company. Knowing this, you can greatly simplify your life and achieve better treatment results. The main thing is not to be afraid to ask for help, to ask questions to professionals who know everything about the compulsory health insurance system and the legislative framework in the healthcare sector. Indeed, sometimes even doctors from medical organizations themselves consult with colleagues – insurance representatives – on certain issues.
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 .
Справка о компании
The SOGAZ-Med insurance company has been operating since 1998. The number of insured persons is more than 19 million people. Regional network – more than 660 subdivisions in 40 constituent entities of the Russian Federation. SOGAZ-Med carries out compulsory medical insurance activities: it controls the quality of services provided to the insured when receiving medical care in the compulsory medical insurance system, protects the rights of insured citizens, and restores violated rights of citizens in the pre-trial and judicial order. In 2018, the Expert RA rating agency confirmed the rating of the reliability and quality of services of the SOGAZ-Med insurance company at the A ++ level (the highest level of reliability and quality of services in the framework of the CHI program according to the applicable scale). For several years now, SOGAZ-Med has been awarded this high level of assessment.