Under the compulsory medical insurance policy, you can take tests for free to diagnose and treat most diseases. Forcing a patient to pay for tests is illegal in most cases, but in order to avoid unnecessary expenses or get money back for paying for procedures in public clinics, you need to know the legal basis for the interaction between medical institutions, their patients and the insurance company.

What tests can be done for free?

The procedure for providing citizens with free medical care under compulsory medical insurance policies is regulated by the following regulations:

• Law No. 326;
• Decree No. 1403;
• laws of the constituent entities of the Russian Federation.

All citizens of the Russian Federation who have received a compulsory medical insurance policy are guaranteed medical care, both under basic and additional (regional) programs. The main program includes not only the treatment of pathologies identified by a doctor, but also the timely detection of such pathologies, as well as preventive measures.

The list of diseases subject to free treatment throughout the Russian Federation is briefly presented in paragraph 6 of Art. 35 of Law No. 326, and is given in more detail in the List of Section 4 of Decree No. 1403.

Free tests are prescribed for the following purposes:

1. treatment of pathologies present in the List;
2. diagnosis of this pathology;
3. diagnosis of possible concomitant pathologies;
4. prevention of suspected pathology and concomitant diseases.

For example, a doctor, based on the symptoms described by the patient, suspects a specific pathology, which is often accompanied by another pathology. If tests for the presence of an underlying disease are free, then tests for the presence of a concomitant disease must also be performed as part of the services paid for by the insurance company.

The basic medical standards by which the diseases listed in the basic and additional programs are treated can be viewed on the website of the Ministry of Health of the Russian Federation.

Among the main free types of analyzes are the following:

• blood test for syphilis - markers, HIV, and other infections;
  blood and plasma tests for the content of basic elements (red cells);
• biochemical studies of blood and lymph;
• analysis of hormone levels;
• tissue biopsy;
• high-tech analytical studies of tissues and organs (MRI, CT);
• X-ray examinations;
• ultrasound analyzes of tissues and organs;
• scrapings and smears of the skin, foreskin and saliva.

Only expensive tests for suspected rare autoimmune or genetic diseases, which occur less than in 0.01% of cases, as well as tests for aesthetic medicine can be paid.

How to check if the analysis is free

To determine the legality of a doctor’s referral for paid tests, you need to find out whether the necessary analysis is included in the list of services provided under the basic insurance program.

It is important to know that the basic list of medical services provided throughout the country can be supplemented by:

• regional medical programs;
• employer programs.

Regional programs are budgetary subventions to pay for services that are not on the all-Russian list, and which are provided free of charge only in a specific subject of the federation. Only patients registered in a given region and who have received an insurance policy from local insurers can receive these services.

In addition, large employers who pay insurance premiums for their employees may provide additional packages of free screening services.

To check whether you can take the test prescribed by your doctor for free, you need to follow these steps:

1. See the presence of the pathology suspected by the doctor in the main list approved by Resolution No. 1403.
2. If the disease is not on this list, find out its presence in the list of services provided by insurers in the region or the patient’s employer.
3. Find out the list of tests required for the diagnosis and treatment of this disease from the standards on the website of the Ministry of Health.

A list of additional regional services can be found on the website of the regional Ministry of Health, and services provided under insurance from the employer are listed in the annex to the employment agreement.

If the disease being diagnosed is included in one of the free programs, and the prescribed tests are included in the standard of treatment for this disease determined by the Ministry of Health, then the patient has the right to undergo this test for free.

How to get directions

At the initial appointment, the patient is often given a referral for tests to a paid clinic under the pretext of the lack of necessary equipment or reagents in this clinic. It is important to know that only the patient has the right to choose the place where medical services are provided. The doctor can only issue a referral for analysis, and the place where the results are submitted and processed are determined by the patient.

Receiving a referral for free tests occurs as follows:

1. the patient consults a specialist doctor to diagnose the disease;
2. the doctor determines what tests the patient needs to undergo and issues a referral;
3. if it is not possible to carry out the analysis in this clinic, the doctor issues a referral to another medical institution;
4. If a clinic employee refuses to give a referral for a free test, you must write a complaint addressed to the manager or chief physician.

If an appeal to the clinic management does not bring results, and the necessary analysis is included in the list of basic or regional services provided under the compulsory medical insurance policy, then the patient should contact a representative of his insurance company.

You can contact either using the hotline or in person at the representative office of the insurer in your locality. Most insurance companies have special departments whose work is aimed at resolving conflicts between medical institutions and patients.

If, after making attempts, a referral for a free analysis is not received, then you should contact the regional health insurance fund. Such funds monitor the activities of private insurers in the context of respect for the rights of insured patients.

In some cases, the financial resources spent by the patient on taking free tests can be returned. You can return funds in 2 ways:

• at the clinic cash desk;
• at an insurance company.

If a patient is referred for a paid test at a referral clinic, then to get a refund you need to do the following:

1. draw up an application addressed to the chief physician for the return of funds;
2. attach to the application a receipt for payment for tests and an agreement on medical services provided;
3. receive an order-resolution on payment of compensation;
4. apply with a copy of the order and passport to the accounting department of the medical institution.

The application indicates the patient’s full name, his registration address and passport details, then you need to state the reasons for the refund, indicate the amount spent and the insurance policy number. The basis must indicate the presence of the submitted analysis in the basic list of services that owners of compulsory medical insurance policies can apply for.

To receive a refund, you must keep the receipt for payment for services and the agreement on paid services.

If the patient was sent to a private clinic for tests, the money spent is returned through the insurer that issued the policy. To do this, you need to contact the representative office of the municipality's insurance company and draw up an application for a refund based on the occurrence of an insured event - the need to submit an analysis from the basic or additional list.

Transfer of money through the insurance company is usually carried out within 3-8 business days. If contributions for the compulsory medical insurance policy are paid by the employer, then compensation can be transferred through the company’s cash desk or to a salary card.

Difficult situations

When applying for compensation or requesting a referral to another medical institution, the patient may face a refusal or a significant delay in the response to the application. In most cases, the situation can be resolved by calling the specialists of the insurance company that issued the policy, or by filing a complaint with the regional compulsory medical insurance fund.

If the prescribed tests are included in the basic list and are an expensive procedure, then the patient has the right to demand the provision of this service free of charge through the judicial authorities. It is important to consider that a referral for tests to another locality or a paid clinic can only be issued under the following circumstances:

• lack of opportunity to conduct these studies in public clinics of a given municipality;
• the current lack of necessary specialists in the clinic;
• lack of prescribed analysis in the basic and additional lists of free services;
• requests from a person from another region for a service provided under the program of a constituent entity of the federation.

The doctor must inform the patient about a free substitute for any medical service provided. Patients are often deceived by being referred for paid tests with the promise of subsequent compensation, to which the patient will not be entitled due to his personal refusal of a free service.

To avoid such deception, you need to carefully review the agreement offered for signature when undergoing paid tests to see if there is a clause on refusal of the free service. If this clause is present, the money spent can only be returned by a court decision.

If a patient is refused a contract and a receipt when receiving a paid service, he or she must refuse payment and file a complaint with the chief physician and the insurance company, since these actions by the staff are illegal.

Conclusion

Holders of compulsory medical insurance policies can take most tests in public clinics free of charge. To exercise your rights, you should look for the prescribed analysis in the list of free services and, if necessary, demand a referral to another medical institution, and to return the money spent, it is important to keep a copy of the contract and receipt. Most difficult situations are resolved by contacting representatives of the insurance company.

What is compulsory medical insurance? What are you entitled to under the compulsory medical insurance policy? How to get or change a compulsory medical insurance policy? How can nonresidents get treatment in Moscow?

If you live in another city and want to come for planned treatment

In this case, there are two scenarios for how you can be hospitalized for free under the compulsory medical insurance policy in a Moscow hospital.

Option 1. Get a referral to a Moscow hospital from the hospital at your place of residence

If you live in another city and want to get scheduled treatment in a Moscow hospital for free, you can receive a referral from a medical institution at your place of residence. You come to your doctor, and if there is evidence, he writes you a referral to one of the hospitals in the capital.

Then you need to make an appointment at the outpatient department of a Moscow hospital (by referral) and receive additional information from the doctor of this hospital about the possibility of hospitalization, the date of hospitalization and a list of necessary tests and documents.

Option 2. Call the hotline for planned hospitalization of out-of-town patients “Moscow - the capital of health”

Today, on the websites of all Moscow hospitals operating under compulsory medical insurance, the hotline number for free assistance in obtaining planned hospitalization for non-resident patients “Moscow is the capital of health” is indicated.

To contact the hotline of the “Moscow - Capital of Health” project, you only need to have an officially established diagnosis and a compulsory medical insurance policy.

The curators of the “Moscow - Capital of Health” project take into account the patient’s wishes regarding planned hospitalization and select a hospital according to the profile of his disease.

The rest depends on the availability of beds in the selected hospitals at the time of the desired date of hospitalization.

In addition, you will be able to receive correspondence advice on choosing a medical institution before arriving in the capital. Doctors preliminarily assess the patient’s condition using medical documents, recommend a hospital, and then he comes to Moscow for hospitalization.

In any case, to decide on hospitalization, an in-person examination will be required to diagnose diseases of unknown origin and concomitant pathologies.

Documents required for hospitalization:

Passport;
- insurance policy (original and copy);
- birth certificate (for children's hospitalization);
- SNILS;
- medical documents.

Hotline specialists supervise the patient until his discharge.

All services are provided free of charge.

This scheme is valid only for receiving assistance under the compulsory medical insurance program. High-tech medical care is directly funded by the state. To receive high-tech treatment, you must apply for a federal quota.

Who is issued the policy and what to do with it?

A compulsory medical insurance policy is issued at birth and is required for every citizen of the Russian Federation. If you have not changed your old policy to a new version, there is no need to worry. Any officially registered policy is valid.

But if there is no insurance policy at all, you will not be able to use free medical care (except for emergency care). You won’t even be able to consult at the district clinic or simply apply for sick leave.

Therefore, if for some reason you do not have a compulsory medical insurance policy at all, we strongly recommend that you apply for it at any compulsory health insurance company in the city at your place of registration, work or actual residence. You can find out which insurance companies operate in your region on the website of the territorial compulsory medical insurance fund of your region. A complete list of territorial foundation websites can be found here.

Both working citizens and unemployed persons, children and pensioners have the same right to receive a compulsory medical insurance policy.

The policy must be presented when making an appointment and in-person visit to the clinic, to doctors when calling an ambulance, when registering for a planned hospitalization, etc.

Insured persons have the right to receive standard dental care, can undergo many tests and examinations free of charge, and as part of additional examinations during treatment - computed tomography and magnetic resonance imaging.

What does a citizen have the right to under the compulsory medical insurance policy?

According to the Federal Law “On the Fundamentals of Protecting the Health of Citizens in the Russian Federation,” an insured citizen has the right to receive emergency and planned care in any medical institution in the Russian Federation (operating under the compulsory medical insurance program) even outside the region of his permanent residence.

For example, you can come from the region to a Moscow hospital according to your profile and, under compulsory medical insurance, receive free conservative and surgical treatment for a wide range of diseases, such as: cholecystitis, urolithiasis, stomach ulcers, hypospadias and phimosis, progressive spinal deformities, valgus flatfoot, Crohn's disease, arrhythmia, adenoids, etc.

A complete list of diseases that can be treated in Moscow under compulsory medical insurance, as well as tests and studies, can be found on the website of the Moscow City Compulsory Health Insurance Fund. Also, a list of services provided in hospitals in your region under the compulsory medical insurance policy can be found in the Territorial Program of State Guarantees of Free Medical Care to Citizens.

Treatment is free, but it's only free for you. The hospital and medical staff receive money for your treatment from the Compulsory Health Insurance Fund. This money is formed from taxes paid by citizens and employers.

In any unclear situation, call the insurance company

If you are denied medical care or are asked to pay money for treatment, but you did not ask for any paid services, your first authority is your insurance company. They are responsible not only for financing the services provided, but also for their quality and timely provision of assistance.

The current number can be found on your new policy (card or A4 document) or on the website of the specified insurance company.

What you are not entitled to under the compulsory medical insurance policy

Compulsory medical insurance does not include:

Treatment without a doctor’s prescription, simply because “I want”;
- cosmetology services;
- treatment with homeopathic medicines and traditional medicine;
- installation of dentures, veneers, etc.;
- accommodation in a superior ward and a personal nurse to boot.

If you are from out of town, but live in Moscow

The possibility and ways of receiving treatment in a Moscow hospital free of charge under compulsory medical insurance for a nonresident patient depend on his goals, capabilities and life circumstances.

For example, being a non-resident living in Moscow, it will be more convenient for you to obtain a Moscow compulsory medical insurance policy.

Its presence will provide you with the right to be assigned to any city clinic operating under the compulsory medical insurance program.

To apply for a compulsory medical insurance policy, you must contact the selected medical insurance organization and provide:

Application for selection/replacement of an insurance company (application form can be downloaded here);
- identification document (passport of a citizen of the Russian Federation, birth certificate, temporary identity card of a citizen of the Russian Federation, issued for the period of registration of the passport);
- SNILS (for persons over 18 years old).

At the time of registration of the policy, the insurance company is obliged to issue a temporary certificate, which provides the opportunity to use similar services of compulsory health insurance. The certificate is valid for 30 working days.

The presence of a Moscow policy provides the opportunity for unhindered attachment to a Moscow medical institution and the right to a full range of medical care, including outpatient care.

More information about all the possibilities can be found on the website of the Moscow City Compulsory Health Insurance Fund.

The Constitution of the Russian Federation guarantees all citizens free medical care under the compulsory health insurance policy (CHI). Types of free assistance provided under the compulsory medical insurance policy:

• primary health care(outpatient clinic);
• emergency,
• specialized medical care(if a diagnosis is established, treatment of a specific disease is carried out)
• high-tech medical care(treatment of diseases using high-tech, complex, costly treatment methods).

The presence of a compulsory medical insurance policy confirms that the patient’s treatment in public and some private clinics will be paid for from the compulsory health insurance fund, which is formed from mandatory contributions from citizens.

Briefly about the compulsory medical insurance system

Payment for treatment in the compulsory medical insurance system occurs at specially formed tariffs for each disease, but does not depend on the method of treating this disease. Tariffs are the same for all medical institutions. The compulsory medical insurance tariff specifies how many and what procedures, tests and studies the clinic can and should perform in the treatment of a particular disease.

Tariffs are the same for all clinics, which means that the patient can choose a more high-tech and well-equipped clinic, regardless of the cost of treatment. The insurance company will handle settlements with the clinic.

Some expensive procedures within the compulsory medical insurance system can only be performed if strictly necessary, which the clinic must prove, otherwise they simply will not be paid for by the compulsory medical insurance fund. Therefore, treatment of patients in the compulsory medical insurance system, unfortunately, has its limitations.

Medical institutions are forced to work according to the rules established by the Compulsory Medical Insurance Fund for each disease. It is important to say that the provision of high-tech medical care (HTMC) to patients, the so-called “quota” treatment, is also paid for from the compulsory medical insurance fund and, accordingly, is carried out according to the algorithms prescribed above.

But the tariffs of the VMP system are higher and are designed specifically to provide complex, high-tech treatment, which allows the clinic staff to use all the power of modern treatment methods, advanced technologies and high-quality consumables.

Not all hospitals in Russia have the right to provide high-tech medical care. Every year, the Ministry of Health of the Russian Federation creates a list of clinics that can treat patients with VMP. Selected clinics receive a so-called assignment from the Ministry of Health, which determines the number of patients that the hospital can treat under VMP.

In medical centers of federal significance, only high-tech and specialized medical care is provided under the compulsory medical insurance policy. The Clinic of Coloproctology and Minimally Invasive Surgery is part of the First Moscow State Medical University named after. Sechenov, accordingly, the same requirements apply to her.

How to get medical care under the compulsory medical insurance policy?

Option 1. By referral from the clinic

The compulsory medical insurance policy itself is required. If it is not there, and you are a citizen of the Russian Federation, you need to contact an insurance company that works with the territorial compulsory medical insurance fund, write an application and immediately receive a temporary policy, and after about a month, a permanent compulsory medical insurance policy. After receiving the compulsory medical insurance policy, you need to be assigned to a clinic, which you can choose yourself. After this, you can qualify for high-tech medical care under the compulsory medical insurance policy.

Referral from the clinic to which the patient is attached (at his place of residence or at his choice). Such a referral to a city hospital or federal center is issued to a patient if the clinic doctors cannot independently diagnose the patient or provide treatment. A referral from the clinic allows the federal medical institution, which is the First Moscow State Medical University named after. Sechenov and our Clinic, provide the patient with primary, specialized and high-tech care.

At the clinic, you can receive both a referral for a free consultation in our Clinic and a referral for free treatment.

Option 2. Referred by doctors from our Clinic.

In some cases, doctors at the Clinic of Coloproctology and Minimally Invasive Surgery can also issue referrals for treatment. The number of referrals is limited and applies to certain types of diseases or complications.

You can find out about the possibility of free treatment under the compulsory medical insurance policy during a face-to-face consultation with a doctor. In this case, you will bypass the stage of agreeing and receiving a referral at the clinic. Please note that referrals for compulsory medical insurance treatment, which are issued directly at our Clinic, have a limited number.

To make a referral under the compulsory medical insurance policy through a doctor at the KKMH Clinic, you will need:

1. compulsory medical insurance policy
2. independent visit to the clinic only for treatment (not carrying out a set of diagnostic measures) with an already established diagnosis

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