You have almost certainly heard the following news: "If you are over 40 years old, even if there are no more funds, you benefit from reimbursed medical analyses"
Those over 40 were relieved because they had heard too many times that there would be no more funds after July 2021. So, how are things going?
We have developed a small practical guide for patients over the age of 40 who want to benefit from this circumstance (medical analyses reimbursed by the Health Center, even if the funds have been exhausted).
WHAT MEDICAL ANALYSIS ARE YOU ENTITLED TO EVEN IF "THERE ARE NO MORE FUNDS AVAILABLE"?
It is important to understand the following because there are only certain services we can receive if we are over the age of 40.
Several conditions must be met simultaneously:
- You are over the age of 40.
- You have no symptoms (you have no signs of illness)
The suggested medical tests are preventative in nature and are included in the basic service package.
La Câmpul 3 – “Cod diagnostic”, pentru biletele de trimitere emise de medicii de familie prin care se recomandă investigaţii paraclinice – analize medicale de laborator în cadrul consultaţiilor preventive din pachetul de bază pentru medical de familie va trece, în căsuţa “PREV” cifra 5 – pentru persoanele asimptomatice cu vârsta de 40 de ani şi peste.
Even if no more funds are available, if you are an asymptomatic adult aged 40 and over, and only one or more of the medical analyses listed below will be performed (what the family doctor recommended)
• Complete blood count
• VSH
• Blood sugar
• Total serum cholesterol
• LDL cholesterol
• Serum creatinine
• PSA in men
• TSH and FT4 in women
DENIAL OF MEDICAL SERVICES UNDER THE ABOVE CONDITIONS CONSTITUTES AN ABUSE
Careful! It is an abuse to be refused medical services! It must be investigated and sanctioned!
Even if you meet the above conditions, sometimes, the Analysis Laboratories will tell you that you can go to other laboratories because they cannot perform these medical analyses.
Under these conditions, it is advisable (if you meet all of the conditions listed above) to file a complaint with the Health Center because you are being denied a right and this is an abuse. https://cnas.ro/raporteaza-un-furnizor/).
The only reason for these refusals is that the respective suppliers are convinced that the settlement of the amounts will be delayed when reimbursed, but that is not our job as the Patient, but the contractual relationship between the Supplier and the Health House.
THE LEGISLATION THAT CERTIFIES THE RIGHTS IN THE PRACTICAL GUIDE
- Annex 18 "MODALITIES OF PAYMENT in specialized ambulatory medical assistance for paraclinical specialties" from the METHODOLOGICAL RULES of June 29, 2021 for the application of Government Decision no. 696/2021 for the approval of the service packages and the framework contract regulating the conditions for the provision of medical assistance, assistive technologies and devices within the social health insurance system for the years 2021-2022
https://legislatie.just.ro/Public/DetaliiDocumentAfis/244166
- BASIC SERVICES PACKAGE IN PRIMARY MEDICAL ASSISTANCE - point 1.2: Preventive and prophylactic medical services
(http://www.casan.ro/page/pachetul-de-servicii-de-baza-in-asistenta-medicala-primara.html)
ADDITIONAL INFORMATION
The medical laboratory analyses are the ones recommended by family doctors to asymptomatic people over the age of 40 as part of the basic package, and the amounts contracted with health insurance companies can be supplemented by additional documents at the end of the month in which they were granted, within the limits of the funds allocated to medical assistance in the specialized outpatient clinic for paraclinical specialties. The providers will send to the health insurance company monthly, along with the activity reporting for settlement, a centralizer whose model is provided by order of the president of the National Health Insurance Company, for the aforementioned paraclinical investigations.
Preventive consultations to assess individual risk in the asymptomatic adult, which are given actively to adults in the general population - without signs of disease - will be carried out as follows.
By age group, preventive and prophylactic medical services include:
Preventive consultations to assess individual risk in the asymptomatic adult, which are actively provided at the family doctor's office to adults in the general population - without signs of disease - will be carried out as follows:
- All asymptomatic individuals between the ages of 18 and 39 - once every three calendar years - for whom the family doctor evaluates exposure to risk factors by completing the riskogram for the appropriate age and sex group according to annex no. 2 B to order In the year in which the individual risk assessment is performed, a maximum of two consultations/insured is agreed upon. Preventive evaluation consultations are granted annually to asymptomatic persons between the ages of 18 and 39 who are identified as high risk, with a maximum of two consultations/insured settled annually. The second consultation is granted within 90 days of the initial consultation.
- All asymptomatic people over the age of 40, once a year - for whom the family doctor evaluates risk factor exposure by completing the riskogram for the appropriate age and sex group according to Annex No. 2 B to order. A maximum of two consultations per insured person per year. The second consultation is granted within 90 days of the initial consultation.
The following paraclinical studies are recommended for prevention:
a. for the asymptomatic adult between the ages of 18 and 39 years
• Complete blood count
• VSH
• Blood sugar
• Total serum cholesterol
• LDL cholesterol
• Serum creatinine
b. for women between the ages of 18 and 39 who are planning a pregnancy
• VDRL sau RPR
c. for asymptomatic adults aged 40 and over
• Complete blood count
• VSH
• Blood sugar
• Total serum cholesterol
• LDL cholesterol
• Serum creatinine
• PSA in men
• TSH and FT4 in women
You can also learn more about the types of tests that are required after 40 years by visiting the following link: https://www.sanador.ro/blog/10-investigatii-medicale-obligatorii-dupa-40-de-ani .
All county health centers have sent the following address to service providershttp://cas.cnas.ro/casdb/media/postFiles/ASIG.%20PESTE%2040%20ANI.pdf ):
