Implementation of Rights with Specialists, in Hospitals and Clinics

When a personal physician determines that an insured person needs an examination by a specialist or treatment in a hospital, s/he issues the person with an appropriate referral order, in which, s/he communicates to the specialist the fundamental details and their requirements concerning the necessary check-ups, examinations, or suggestions for treatment.

Commonly, the personal physician also advises us as to which specialist or medical institution we should visit. Alternatively, we may select another institution or private specialist from among those who have contracts concluded with the Institute and are qualified for the suggested operations. In this respect, we should bear in mind that the insured person, while entitled to the reimbursement of travelling expenses when the diagnosis, treatment or rehabilitation dictates travelling to another area, is only entitled to the expenses of travelling to the nearest qualified service provider.

Commonly, the specialist performs the particular service relating to the referral, which they have been authorised or requested to do by the personal physician. If, on the contrary, in the referral, the personal physician requests that the specialist also continue the treatment, then the specialist must in turn refer the insured person elsewhere if necessary and determine the appropriate treatment, including prescribing medicaments and check-ups. We should bear in mind that an insured person has the right to treatment by a specialist only in the case that such treatment is determined necessary by their personal physician, and not necessarily whenever desired.

In the case of the insured person's health condition (a chronic illness) requiring continuous cooperation with a specialist, the personal physician may elect to transfer that part of his powers concerning diagnosis and treatment of the particular disease, including the prescription of medicaments and referral to other specialists or to a hospital, to the implicated specialist, who must in turn regularly inform the personal physician of their measures and the course of treatment. The authorisation has a limited period of validity and must be renewed at least each year. The period of validity is specified by the personal physician.