Experts explained how realistic it is to change a clinic in modern conditions
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Compulsory medical insurance experts joke: people don’t fall from the spinning Earth just because they are assigned to clinics. However, this does not mean at all that your clinic should be with you now, and forever, and forever and ever. The law allows you to change it. And not even just once. How to do this correctly, quickly and conveniently? How to attach to an outpatient facility if you haven’t done so yet? About all this – in the material “MK”.
First you need to remember that you can change the clinic at least 1, at least 2, at least 22 times, but by law you can do this no more than once a year. The law allows the owner of a compulsory medical insurance policy to choose any clinic that he likes, where it would be convenient for him to be treated and examined. The reasons for choosing are not regulated in any way by law – a primary care facility may be located far from your home (for example, on the way to work) or you are simply attracted by its high rating and good reviews. “In any case, the insured person makes the decision independently. The main condition is that the medical organization must be registered in the territorial program of state guarantees of free medical care and provide primary health care, including on a territorial-precinct basis. Information about this can be found on the websites of medical insurance organizations and territorial compulsory medical insurance funds,” says Mikhail Pushkov, a member of the working group on the development of compulsory medical insurance of the All-Russian Union of Insurers.
An important point: detachment from the previous clinic occurs automatically; you do not need to do anything special for this.
Today, all clinics in the country operate on the basis of the principle of per capita financing. This means that the entire primary health service directly depends on the size of the attached population. The main idea is to encourage clinics to provide high-quality outpatient medical care.
And yet, clinics have restrictions on the number of patients assigned to them, since they are subject to clear standards tied to the number of specialists attending, the size of medical institutions, etc. So, if some medical organization is already overloaded with patients, new ones may be denied admission to on this basis. And the refusal will be completely legal. One subtlety: it must be officially confirmed. You should be given a corresponding letter of refusal indicating the reason in paper form or sent to your personal account on the State Services portal if you submitted an application through this service. If you think that the refusal is unlawful, contact the insurance company that issued your compulsory medical insurance policy. Its employees will check the documents to determine the legality of the refusal.
If a patient moves to another region, a change of clinic becomes an inevitable event for him. In such a situation, in order to make the transition quickly and without problems, you will need a document confirming the change of residence, for example a temporary registration document or a rental agreement. And yet, compulsory medical insurance experts warn that a frequent reason for denial of registration is the absence in the region of the medical insurance organization that issued the compulsory medical insurance policy. The good news is that such refusals are completely unlawful: the patient’s insurance affiliation is not the reason for refusal to join; by law, the compulsory medical insurance policy is valid throughout our country.
Although there are some nuances. “The reason is the organizational and financial aspect of receiving medical care. There is a basic program of state guarantees, it is uniform for the entire country, and within its framework there are very broad opportunities for receiving medical care. But each region also has a territorial program, which may be a little wider, but no less in terms of the volume of medical care than the basic program. Payment for medical care and verification of the quality of its provision are carried out by medical insurance organizations. If there is no health insurance company in the region that issued a compulsory medical insurance policy to the patient, payment for his medical care should be made by the territorial compulsory medical insurance fund within the framework of the basic program. In this case, they cannot refuse to assign you to a specific clinic. But if this suddenly happens, you need to receive a letter of refusal from the medical organization indicating the reason, and then contact the territorial compulsory medical insurance fund directly to resolve this situation. However, if a patient is interested in receiving medical care under a territorial program, which is broader than the basic one and operates in a new region of residence, then it is easier to choose another medical insurance organization – from those that exist in this region,” explains Mikhail Pushkov.
Let us remind you that the CMO, like the clinic, can also be changed. Registers of medical insurance organizations operating in the region are published on the websites of territorial compulsory medical insurance funds. If the CMO is represented in a new region, you just need to provide it with your new contact information.
What are the pros and cons of choosing clinics in terms of access to medical care? The main disadvantage is that if you change your clinic to one that is located far from your home and is not part of your outpatient complex, you will have to take into account the fact that it will be impossible to call a doctor at home from this medical institution. And yet you will not be left without a doctor at all: he will be sent from the clinic at your place of residence. In this case, all subsequent scheduled visits to the doctor and examinations (including tests) while on sick leave will be carried out at the medical institution at the place of your choice. Please note that this may not always be convenient for you. But if you wish, you can do this at your place of residence, but on a paid basis.
The child must be assigned to the clinic on the day of treatment, and the assignment of adult patients takes up to six working days.
What documents will be needed to attach? Adults will need a compulsory medical insurance policy (or an extract from the Unified Register of Registered Persons), a passport and (in case of moving) a document confirming residence in the new region.
For children under 14 years of age, a birth certificate, SNILS (if available), a document on permanent or temporary registration and a passport of one of the parents (or legal representatives) are required.
The right to choose a medical organization is enshrined in Art. 21 of the Law of the Russian Federation No. 323-FZ “On the Fundamentals of Health Protection”, and the procedure for choosing a medical organization by a citizen was approved by order of the Ministry of Health and Social Development of the Russian Federation dated April 26, 2012 No. 406n. If you still have difficulties connecting to a clinic, you need to contact the insurance company; its contact information is always indicated on your medical policy.
Newspaper headline:
Unfasten and heal
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