10 health care services you should get for free but cost money

2024 Author: Malcolm Clapton | [email protected]. Last modified: 2023-12-17 03:44

The compulsory medical insurance policy is not just a piece of paper, but a working tool for treatment and prevention. You just have to learn how to use it.

What free medical care is required under the compulsory medical insurance

Within the framework of the compulsory medical insurance system, there are basic and territorial programs of state guarantees for the provision of free medical care to citizens. The basic provides that citizens must provide free of charge:

• primary medical care, which includes prevention, diagnosis, treatment of diseases, management of pregnancy;
• specialized, including high-tech assistance - actions similar to the previous paragraph, requiring special methods and complex medical technologies;
• ambulance;
• palliative care - relief of pain and disease manifestations of terminally ill patients.

The document also lists the diseases and conditions for which medical care should be provided free of charge. In 2018, these are:

• infectious and parasitic diseases;
• neoplasms;
• endocrine system diseases;
• eating disorders and metabolic disorders;
• diseases of the nervous system;
• diseases of the blood, blood-forming organs;
• certain disorders involving the immune mechanism;
• diseases of the eye and its adnexa;
• ear and mastoid diseases;
• diseases of the circulatory system;
• respiratory diseases;
• diseases of the digestive system, including diseases of the oral cavity, salivary glands and jaws (with the exception of dental prosthetics);
• diseases of the genitourinary system;
• diseases of the skin and subcutaneous tissue;
• diseases of the musculoskeletal system and connective tissue;
• injury, poisoning and some other consequences of external causes;
• congenital anomalies (malformations);
• deformations and chromosomal abnormalities;
• pregnancy, childbirth, the puerperium and abortion;
• certain conditions that occur in children during the perinatal period;
• mental and behavioral disorders.

The list also includes symptoms, signs and abnormalities that are not classified as diseases and conditions. Accordingly, you should receive medical assistance for any of these ailments free of charge.

In each constituent entity of the Russian Federation, the regional government develops and approves a territorial program of state guarantees for the provision of free medical care to citizens. You can find it, as a rule, on the website of the local Ministry of Health or a unit with a different name, but with similar functions, as well as on the website of the Territorial MHI Fund. Regional programs can expand the range of services provided under the policy, but not curtail it.

What excuses do the hospital use to make you pay for the service?

This is not included in the standard, there is no tariff for the service

For many diseases, there are standards approved by the Ministry of Health and Social Development, which prescribe what, when and how often a patient needs to do. Even if the diagnosis and treatment requires something that is not in the standard, the provision of assistance is provided for by the state guarantees program. By the way, it does not say anything about leaving the patient writhing in pain on the doorstep of the clinic if there is no tariff for help.

This is not an appointment, but a recommendation

What the doctor prescribed is included in the compulsory medical insurance framework and is paid from the fund, because he acts in accordance with the standards. At the same time, the recommendation seems to be not obligatory for implementation, and therefore you can be provided with the appropriate service only for money.

But it is important to distinguish one from the other. For example, with osteochondrosis, the doctor may recommend preventive gymnastics between exacerbations in order to alleviate the condition. And an X-ray is a prescription necessary for a diagnostic picture, and it cannot be a recommendation.

The institution does not have an MRI or ultrasound machine

You should be referred to a CHI facility that has equipment. These studies are needed to make some diagnoses. The absence of a device does not mean that the doctor should read the tea leaves if the patient cannot get a service for money.

What services can you get for free, even if you are asked to pay

1. Analyzes of thyroid hormones

If you have ever faced the need to study thyroid hormones, you may have heard from a doctor that “simple” tests will be done in a polyclinic, but for “complex” ones there is no equipment in the institution. However, the reasons may be different, the result is the same - in accordance with medical standards, according to the policy, you must do the following research:

• the level of free triiodothyronine (T3);
• the level of free thyroxine (T4);
• thyrotropin;
• antibodies to thyroglobulin;
• antibodies to thyroperoxidase;
• antibodies to the thyroid-stimulating hormone (TSH) receptor.

With non-toxic goiter, additional tests are added to the list, which are necessary for the diagnosis.

2. Help with obesity

Overweight people are usually sent to the gym and to nutritionists, which requires significant amounts of money. At the same time, obesity is a disease that is treated under the compulsory medical insurance.

The doctor should determine the causes of excess weight (overeating, taking medications, and so on). The standard includes an appointment with a gynecologist, urologist, cardiologist, endocrinologist, psychiatrist and even a nutritionist, various studies.

In addition, according to the standard, you must calculate the daily calorie intake, taking into account body weight and physical activity. A doctor with a specialized education will probably do better than a self-proclaimed nutritionist from Instagram.

3. In Vitro Fertilization

Since 2013, the expensive IVF procedure has been included in the compulsory medical insurance program. True, to participate in it, one policy is not enough.

Patients who are indicated for in vitro fertilization are selected by a special commission based on the results of analyzes and studies. Which, by the way, are also made according to the policy.

At the same time, the compulsory medical insurance program does not provide for the use of donor embryos or eggs and surrogacy. But since 2018, it is possible to carry out free cryopreservation of embryos obtained as part of the IVF procedure.

4. Provision of medicines in the hospital

This applies to both round-the-clock and daytime hospital stays: the institution must fully provide you with the necessary drugs.

5. Consultation of a narrow specialist

You are not denied admission, but they say that you will have to wait a month, or even more, since the specialist is busy. But "through the cashier" he is ready to examine you today. A logical question arises: if he is busy, how will he find time for a paying patient?

The program of state guarantees for the provision of free medical care to citizens prescribes the waiting times:

• reception by a therapist - no more than 24 hours from the moment of contacting a medical organization;
• consultations with a specialist doctor - no more than 14 calendar days;
• diagnostic and laboratory tests - no more than 14 calendar days.

6. Dental services

It is better to check the exact list of the services provided on the website of the Territorial MHI Fund in the general tariff agreement for the current year. At a minimum, you can:

• get anesthesia (except for orthopedic work);
• cure tooth decay;
• remove dental plaque;
• learn oral hygiene under the guidance of a specialist.

The list of free services is quite long and more extensive than one might think when it comes to free dentistry. You may be offered an additional service for money, but you will not be blackmailed by drilling a tooth without anesthesia if you do not pay.

7. MRI, CT and ultrasound

You should be examined free of charge, but only as directed by your doctor. The doctor will refer you to a procedure if he considers it important for diagnosis and treatment. But you are not obliged to serve your hypochondria and satisfy the desire to be examined from crown to heel according to the policy, for this you need specific complaints.

8. Massage

If the services of a massage therapist are necessary for treatment, they should be provided to you free of charge. But a doctor's appointment is necessary.

9. Vaccinations

The vaccine for infections on the National Immunization Schedule is also available free of charge. It contains:

• Hepatitis B;
• diphtheria;
• whooping cough;
• measles;
• rubella;
• polio;
• tetanus;
• tuberculosis;
• parotitis;
• hemophilic infection;
• pneumococcal infection;
• flu.

10. Depression

The Ministry of Health's website has a Standard for Primary Health Care for Depression. According to the document, at the diagnostic stage, for example, you can be examined by a psychotherapist, psychiatrist, psychologist.

How to understand if you are entitled to a service

The easiest way is to call the insurance company and ask. Her number is indicated directly on your policy. But if you're used to not trusting anyone, follow the algorithm.

1. Check if there is a suspected or identified disease in the basic program of state guarantees for the provision of free medical care to citizens.

2. If not, study the territorial program on the website of the local Ministry of Health or TFOMS.

3. Find the standard of care in case of illness on the website of the Ministry of Health: select a class from the drop-down menu, then find it in the list.

4. Study the standard. In it you will find services that are provided for the diagnosis (section 1) and treatment (section 2) of the disease. All of them, if necessary, should be provided to you free of charge.

What to do if the service is supposed to, but it is denied

According to the leading lawyer of the European Legal Service Oksana Krasovskaya, if you are denied free medical care and it is impossible to resolve the issue within the medical institution, you should file a complaint:

• to the medical insurance organization, the phone number of which is indicated on the insurance policy;
• to the Territorial Fund of the CHI (the phone number can be found on the organization's website or on information stands in a medical institution);
• to the territorial health management body - a profile committee, department, and so on;
• to the Federal Compulsory Medical Insurance Fund (telephone of the department for the protection of citizens' rights in the compulsory medical insurance system - +7 (495) 870-96-80.

Oksana Krasovskaya leading lawyer of the European Legal Service

On complaints, the insurance organization will check the quality of medical care in the institutions. If the facts of violations of the rights of citizens are established, the company may refuse to pay for services to the medical institution or demand compensation for damage caused to the insured through the court.