CHI Foundation Urges Patients To Seek Protection From Insurance Representatives

CHI Foundation urges patients to seek protection from insurance representatives

For three years in the country there has been an institute of insurance representatives working in all insurance medical organizations. issuing compulsory medical insurance policies. But so far, very few people know about this, as well as about the fact that it is they who, according to the law, must solve the problems that arise when receiving medical care for free and protect the rights of patients in controversial situations.

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For three years in the country there has been an institute of insurance representatives working in all insurance medical organizations. But so far, very few people know about this, as well as about the fact that it is they who, according to the law, must solve the problems that arise when receiving medical care for free and protect the rights of patients in controversial situations. This means that if any problems arise, you should immediately contact the insurance company that issued the OMI policy.

Today, more than 14 thousand insurance representatives work in insurance companies, the main goal of which is to ensure the rights of citizens insured under compulsory health insurance to receive affordable and high-quality medical care under the state guarantees program, the Federal Compulsory Health Insurance Fund said. Those who have completed special training (including those with a medical education) must help patients at all stages of treatment, advise on any issues related to obtaining medical care, conduct quality examinations, and, if necessary, provide legal support.

As the MHIF admits, patients and their relatives often face problems during hospitalization, receive unreasonable refusals in medical care, we doubt the correctness of the doctor's prescriptions or the diagnosis. Often there are doubts and requests to pay for this or that medical service.

When you need an insurance representative:

Unjustified refusal to receive medical assistance under the CHI program

• Violation of the timing and availability of medical care
• Offer to pay for a particular medical service
• Difficulties in hospitalization
• Questions about the diagnosis
• Doubts about the quality of the medical care provided

If a chronic disease, including cancer, is detected

The insurance representative will provide individual information support in the process of providing medical care.

• Will inform you about the need for dispensary observation and the prescribed treatment.
• Will control: the timeliness of referrals for examinations and consultations to specialist doctors
• organization and timing of hospitalization, including high-tech medical care

Your insurance representative can provide information on:

Rights under the program of state guarantees

• Rules for choosing and replacing an insurance medical organization, a medical organization and an attending physician
• Types and conditions for the provision of medical care under compulsory medical insurance
• Terms of receiving medical assistance
• Procedures and timing of preventive measures
• Will inform you about the possibilities of undergoing preventive examinations and medical examination: the insurance representative will inform you in a convenient form about the time, place and procedure for taking professional events in accordance with your gender and age
• find out the reasons for the untimely passage of preventive measures
• in case of difficulties of problems during the passage of medical examination, will help to solve them

How to find an insurance representative

In most cases, a call to the contact center phone number indicated on the memo received when issuing the compulsory medical insurance policy, as well as on the website of the medical insurance organization, is sufficient. All major insurance companies have round-the-clock call centers, where they will help to quickly resolve disputes by contacting the right specialist.

What to do if you are offered to pay for medical care required by the CHI

To check the legality of payment, you should contact your insurance company. If there is no reason for payment, then an insurance representative will help you understand the situation. In cases where the patient has already paid for medical care or bought something in a pharmacy while being treated in a hospital in the direction of the attending physician, experts of the All-Russian Union of Insurers advise to keep the receipt / contract for the provision of paid services and transfer it to your insurance company, which organizes the examination. After that, a claim will be filed with the medical organization and a proposal to resolve the conflict out of court. Usually, everything can be resolved at this stage, but if you still have to go to court, the insurance company will help in the preparation of the statement of claim and can act in court as a third party.

Since this year, a step-by-step procedure for accompanying insured citizens has been spelled out, recalls the chairman of the Federal MHI Fund Natalya Stadchenko. And contacting your insurance company is absolutely the right step. “Moreover, we urge patients to do this at the time of treatment. This will allow not to bring the problems to a critical level,”Stadchenko notes.