Do you want to go to a sanatorium with the National He alth Fund? At the beginning, you need a medical referral with a justification and a suggested place of treatment, which is sent to the Provincial Department of the National He alth Fund. Check if you are en titled to a sanatorium and what the entire document approval process looks like.
Who can go to a sanatorium at the National He alth Fund?
A he alth insurance doctor issues a referral for spa treatment, taking into account:
- indications and contraindications for spa treatment or spa rehabilitation;
- in the case of adults - recommended frequency of spa treatment or spa rehabilitation, but not more often than once every 18 months.
Choosing a sanatorium
NHF referral to a sanatorium
In the referral, the doctor may specify the place and type of spa treatment or rehabilitation. This choice is not binding on the Provincial Branch of the National He alth Fund. The doctor issuing the referral is obliged to fill in the referral correctly and legibly. The prepared form is sent to the Provincial Department of the National He alth Fund in a sealed envelope with the words "REFERENCE TO HEALTH TREATMENT" or "REFERENCE TO HEALTH REHABILITATION".
After receiving a referral by the National He alth Fund in the appropriate cell of the Branch, it is registered by entering it on the list of referrals and the referral is made with the number of the entry under which the referral was entered on the list of referrals. Then, after registering the referral, a specialist in balneology and physical medicine or medical rehabilitation, employed in an organizational unit, approves the referral in terms of the purposefulness of spa treatment or spa rehabilitation.
The specialist doctor may request the doctor who issued the referral to provide, within the prescribed period, the medical documentation necessary to determine the type and scope of spa treatment or spa rehabilitation, supplement or update this documentation and conduct additional tests.
Acceptance of referral to a sanatorium by the National He alth Fund
The Provincial Department of the National He alth Fund accepts a referral, if:
- the specialist doctor approved the advisability of the referral;
- wthere are vacancies provided for in the agreements with these institutions in the relevant spa treatment or spa rehabilitation facilities.
When confirming the referral, the Provincial Department of the National He alth Fund specifies:
- type of spa treatment or spa rehabilitation and their mode;
- appropriate spa treatment facility or spa rehabilitation;
- date of starting treatment or spa rehabilitation; in the case of spa treatment in stationary conditions - duration;
- treatment period, in the case of spa treatment on an outpatient basis or spa rehabilitation.
In the case of referral for spa treatment on an outpatient basis, confirmed by the competent Provincial Department of the National He alth Fund, the beneficiary agrees the date of starting the spa treatment with the indicated sanatorium center to which he was referred, no later than 14 days before the date of treatment commencement. The he alth resort treatment facility confirms to the recipient the agreed date of starting the spa treatment on an outpatient basis in written or electronic form.
Providing the confirmation of referral and information about payment for the stay in the sanatorium
Then the provincial branch of the National He alth Fund delivers the recipient a confirmed referral no later than 14 days prior to the commencement of treatment. When delivering a referral for treatment at a he alth resort sanatorium, the provincial branch of the National He alth Fund informs about the rules of payment for the stay, and if applicable, also about the total costs for the caregiver's stay.
When the National He alth Fund does not accept a referral to a sanatorium?
A referral, which the Provincial Department of the National He alth Fund has not confirmed in the case when the specialist doctor did not approve the purposefulness of the referral, is returned to the doctor who issued it, along with the reason for refusing to confirm the referral. The Provincial Department of the National He alth Fund notifies the recipient of the refusal to confirm the referral together with the reasons for the refusal to confirm the referral, no later than 30 days from the date of receipt of the referral. There is no appeal for not confirming the referral.
The referral with the current test results and information card from hospital treatment, if the spa treatment is a continuation of hospital treatment, is verified every 18 months from the date of its issuance. Legal basis: Regulation of the Minister of He alth on referral to spa treatment or spa rehabilitation of 7 July 2011 (Journal of Laws No. 142, item 835)