The establishment of a verification system for the insured under the National Health Fund is demanded by doctors associated with the Federation of the Wielkopolska Association of Zielona Góra, informed the President of the Federation, Bożena Janicka.
The NHF reimburses doctors for advice for insured persons on the basis of entries in the Central Register of Insureds (CWU). In order to be included in the list, the patient has to pay health insurance contributions to ZUS or KRUS, and these institutions report him to the Central Register of Insureds.
Doctors are required to check the patient’s insurance by checking: health books with current employers’ stamps, or health insurance payment certificates to ZUS or KRUS.
If the patient has a stamp in the booklet and is not entered in the CWU, the National Health Fund does not want to pay for such a service when settling our contract, said Janicka during the press conference.
According to the Zielona Góra Agreement, it is necessary to introduce the Health Insurance Card, which has been announced for many years.
If there was an electronic Health Insurance Card, I would know if the patient has insurance by inserting it into the reader or typing the patient’s PESEL number into the computer, and so I give advice, write out medications, and if the patient is insured or not, I will find out only after verification carried out by the National Health Fund – Janicka explained during the conference.
According to Janicka, ZUS and KRUS are obliged to provide information to CWU about the right to insurance or about its loss within two months.
And at that time, many thousands of people, despite paying contributions, may not be registered with the SSC and are not entitled to benefits. And the National Health Fund does not want to pay us for these services – said Janicka during the press conference.
She could not calculate exactly how many people this case could concern or estimate the losses that doctors or hospitals suffer from the leakage of the system.
As PAP was informed in the Wielkopolska Branch of the National Health Fund, the Central List of Insureds is not created by the National Health Fund. It is a database created by the insurers, i.e. ZUS, KRUS or the Ministry of the Interior and Administration. The data it contains is updated from time to time.
And so – at the end of July we have data from May. Hence, there may be situations when a person who, for example, was registered for insurance in the last month, does not yet appear in the CWU, despite the fact that he is entitled to benefits – explained the spokesman of the Greater Poland NFZ Marta Banaszak – Osiewicz.
Regarding non-payment for advice for unauthorized persons, the National Health Fund in Poznań explains that invoices for service providers are paid on an ongoing basis, and the provincial branches of the National Health Fund are responsible for explaining such cases.
We then check whether a given person has the status of an insured person, and if not – whether he or she is entitled to benefits – here, inter alia, about children and adolescents up to 18 years of age or pregnant and postpartum women – Banaszak told PAP.
Doctors can verify whether the patient is insured or not – checking whether he has a valid document confirming the insurance and thus entitling him to free health services.
According to the National Health Fund, the lack of such a document in the event of a threat to life or health cannot be the basis for refusing to provide a patient with medical assistance, but the patient is required to present a document confirming his right to benefits within 7 days of his discharge from the hospital.
According to the data of the Greater Poland NFZ, out of nearly 3.800.000 people included in the CWU from the Greater Poland branch, only 1,5 percent has the status of an uninsured person. people (data from June 2010). (PAP)