Are You Getting Access to the Medical Care You Are Entitled to?

Posted Dec 18, 2019

by Ambra Andrei

Content Manager

Do you need a knee or hip replacement but are on a waiting list forever?

Within the UK & Ireland, patients can wait up to 18 weeks and in some cases up to 18 months for knee and hip replacements. In Lithuania or Poland with accredited hospitals, you can have your surgery in as little as 2 weeks, with an outcome that is equal to or if not better than what you would expect back home.

In the UK or Ireland, many patients are not getting the care (sometimes urgent) that they require due to limited resources that result in long waiting lists or extremely high treatment costs if they wish to go private.

Many people don’t know that high-quality, cost-effective options are available throughout Europe. The European Cross Border Directive is in place to offer financial support to those who choose to go abroad for treatment.

No matter the treatment you need, or where you travel to get it done, we know that you want to be in the best hands. Choosing a foreign destination for your medical treatment, let alone the hospital or the doctor, can get really confusing, and you might not know where to start.

Qunomedical would like to help you access your right to medical care within Europe by highlighting your entitlements according to the The European Cross Border Directive.

The European Cross Border Directive

According to the The European Cross Border Directive published in 2004, patients may travel to another Europe country to receive medical care and can be reimbursed based on tariffs and rights in their local area. That means that you will be reimbursed if prices are equal or cheaper to that of your home country - if the cost is more, you just have to pay the difference yourself.

Healthcare costs are covered. The Directive supports medically necessary care, and in cases of planned treatment prior authorisation is required.

So how do I use it?

UK

You can apply through the EU Directive, or for NHS-funded treatment via the S2 Route.

The EU Directive Route

The EU directive route is available for either state-funded or private treatment abroad.

If you fulfil the eligibility criteria, the EU Directive route may entitle you to access healthcare in another European Economic Area (EEA) country, except Switzerland. Only treatments that would be available to you on the NHS are included, unless there are exceptional circumstances.

Payment is made upfront to the hospital or clinic. When you’re home, you can claim for reimbursement up to the amount the treatment would have cost on the NHS in England. It can take up to 20 working days for an application to be processed.

If you apply for reimbursement after treatment or authorisation in advance of treatment, you will need to complete an application form.

Please ensure to include the following with your application:

  • Admission and discharge dates

  • Estimated costs

  • Original receipts and proof of payment

What is not covered:

  • Travel costs

  • Accommodation costs

  • Any extra costs (allowance for food, etc.)

Eligibility Criteria

  • You are ordinarily resident in England and entitled to treatment on the NHS.

  • The treatment is the same as or equivalent to a treatment that would be made available to you on the NHS. Only in exceptional circumstances will NHS England approve other forms of treatment – you will need prior authorisation for this.

  • The healthcare provider is based in another EEA country and provides the treatment.

  • The treatment is necessary to treat or diagnose a medical condition.

  • You have provided a letter from an EEA clinician – a clinician based in the UK or another EEA country – as evidence that you've had a full clinical assessment. The letter needs to describe your condition and diagnosis, and confirm the medical need for the treatment. The letter must clearly state why the treatment received will be, or was, needed.

You can read more information HERE

The S2 Route

If you choose the S2 route, you may be entitled to NHS-funded treatment in another European Economic Area (EEA) country or in Switzerland.

Eligibility Criteria

  • You are ordinarily a resident in England and entitled to treatment on the NHS.

  • The requested treatment would normally be provided on the NHS to an individual in your circumstances.

  • You have provided written evidence that you have had a full clinical assessment by a clinician in either the UK, any EEA country, or Switzerland. The clinician's statement must clearly state why the treatment you seek is needed in your circumstances, and what the clinician considers to be a medically justifiable time period within which you should be treated again, based on your circumstances. The clinician should support this statement by giving objective reasons.

  • The requested treatment is available under the treating country's state healthcare scheme.

  • Taking into consideration the information provided by the clinician, NHS England has determined that the same or equivalent treatment cannot be provided to you on the NHS within a time period that's medically justifiable.

  • The requested treatment is not experimental or part of a drug trial.

  • The requested treatment is not emergency treatment.

What’s not included:

  • Travel costs

  • Accommodation costs

  • Any extra costs (allowance for food, etc.)

You may be able to claim back some or all of your contributions when you return to the UK.

It can take up to 20 working days for a fully completed application to be processed and an entitlement decision to be made, so make sure you plan your treatment in advance!

You can download your application form HERE. You can read more information HERE.

Ireland

You can apply for the Cross-Border Directive Scheme through the HSE Website. You can reclaim the cost of healthcare up to the maximum amount of its cost in Ireland if you’re eligible for the scheme.

Eligibility Criteria

  • You are ordinarily a resident in Ireland

  • You are entitled to public healthcare in Ireland

  • You must not be in receipt of any state benefit from another EU or EEA member state

  • You are required to travel abroad for the treatment

  • You have a referral for public healthcare from a GP or hospital consultant in Ireland

  • You need to provide a copy of a letter of referral or a letter from a hospital to say you're on a waiting list in Ireland

  • You apply for repayment towards the cost of your healthcare abroad, after you have paid for it

You can not claim reimbursement for:

  • The cost of any medicine you'll need afterwards

  • Any travel costs

  • Any extra costs (allowance for food, etc.)

If you are having healthcare that involves an overnight stay in hospital, you can apply for prior authorisation before you go abroad.

You can download your application form HERE You can read more information HERE

While Qunomedical makes every effort to present accurate and reliable information on this document, Qunomedical does not endorse, approve or certify such information nor does it guarantee the accuracy, completeness, efficiency, timeliness or correct sequencing of such information.

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These are just a few of the benefits you’ll get with us:

✓ You’ll find the best hospitals worldwide in one place - we do the legwork for you! ✓ You’ll get the best price online, as well as the highest quality. ✓ Your travel will be as worry-free as possible - we are available 24/7 and we will be there every step of the way. ✓ You’ll get the final, real price, and no hidden costs!


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