Senior with This Certificate Can Skip the Queue and See a Specialist Without a Referral

Individuals holding a severe disability certificate can access public healthcare services out of turn, visit specialists without referrals, and utilize specific medical rehabilitation rules.

A Person with a Severe Disability Can Skip the Queue to the Doctor

A person holding a severe disability certificate can use health care services out of turn and pharmaceutical services provided in pharmacies. The entitlement results from Article 47c of the Act on healthcare services financed from public funds. It applies to, among others:

Special rules also apply to specific stationary and 24-hour services other than hospital ones, such as services provided by care and treatment centers, nursing and care centers, or hospices.

Out of Turn to the Doctor: The Patient Can Be Admitted on the Same Day

This is one of the most important pieces of information for the patient. An eligible person should not be registered and handled like a patient using the usual waiting list. The outpatient healthcare service and hospital service should be provided on the day of application.

If this is not possible, the facility should set another date, but also outside the queue resulting from the maintained waiting list. In the case of outpatient specialist care, a specific deadline also applies. If the patient cannot be admitted on the day of application, the service should be provided no later than within 7 working days from the day of application.

To a Specialist Without a Referral: An Important Entitlement for Persons with Severe Disabilities

A severe disability gives one more important entitlement. A person holding such a certificate can use publicly funded outpatient specialist services without a referral.

Important

Outpatient specialist care, or AOS, includes treatment that does not require a 24-hour stay in a hospital. The patient comes to the clinic or medical facility for a consultation, examination, or procedure and can return home after it is performed.

Within AOS, the patient can use, among others, specialist advice, diagnostic tests, and selected outpatient procedures and treatments. A specialist doctor assesses the health condition, analyzes test results, and determines further treatment. As a rule, to use specialist advice under the NFZ, a referral from a primary care doctor or another health insurance doctor is needed. However, there are exceptions.

A person holding a severe disability can use publicly funded outpatient specialist services without a referral. These are two separate entitlements: the patient may have the right both to be admitted out of turn and to use AOS without a referral.

Not Every Test is Covered by the Right to AOS Without a Referral: An Important Exception

At the same time, it is worth remembering that the lack of a referral to AOS does not automatically mean the lack of a referral for every test or service performed as part of specialist treatment. For example, in the case of high-cost diagnostic tests, such as magnetic resonance imaging, a referral is still required. A referral is also needed in the case of medical rehabilitation.

It is also worth knowing that general exceptions to the rule of referring patients to a specialist apply. A referral is not required, among others, to a gynecologist and obstetrician, dentist, venereologist, oncologist, and psychiatrist. Without a referral, you can also use certain clinics, including those for tuberculosis patients and HIV-infected persons.

Therefore, a person with a severe disability does not have to obtain a referral to AOS even when a referral to a given specialist is generally required for other patients.

Rehabilitation for Persons with Severe Disabilities: There is an Important Limitation

Persons with severe disabilities also have special entitlements regarding medical rehabilitation. Rehabilitation treatments for persons with severe disabilities are not limited by financing limits and are implemented in accordance with the doctor’s indications. However, this does not mean the abolition of the limit on the number of service days – as a rule, this is up to 80 days in a calendar year.

How to Confirm the Right to a Doctor Without a Queue? These Certificates are Recognized

The basic document is a severe disability certificate issued by:

Certain older certificates and specific certificates issued by ZUS, KRUS, MON, and MSWiA can be considered equivalent. This concerns, among others:

The basis for confirming the status of a disabled person can also be labor and social insurance court judgments issued in appeal proceedings from an appropriate certificate or decision of the pension authority. If the court judgment changes only part of the earlier decision, both the judgment and the appropriate part of the earlier certificate may be needed to determine the patient’s status.

Disabled Person ID and Doctor Without a Queue: When Might It Not Be Enough?

The patient can confirm their entitlements with a disabled person ID. Importantly, the degree of disability is entered into the ID at the request of the disabled person (until August 31, 2017, the degree of disability was entered ex officio). Older documents may therefore not contain information that clearly states that the patient has a severe disability. If this entitlement cannot be confirmed from the presented ID, the facility may ask to show the source document, i.e., the certificate. It is also worth checking the expiration date of the ID.

Doctor Without a Queue: What to Say at Registration and Which Document to Show?

If the patient has a severe disability and wants to use priority, they should inform registration during appointment scheduling. They can report their entitlement in person, and depending on the organization of registration, also by phone. It is best to have a document with you that clearly confirms the right to use services out of turn. In case of doubts regarding the ID, it is also worth bringing the certificate itself.

Can Every Senior Go to the Doctor Without a Queue? Age Alone is Not Enough

Age alone is not enough. Reaching the age of 60, 65, or 70 does not automatically give the right to use NFZ services out of turn. The decisive factor is having one of the documents confirming the special entitlement. Therefore, a senior who does not have an appropriate certificate or other document confirming the entitlement uses the rules regarding queues applicable to other patients.

Can You Choose Any Clinic and Skip the Queue to the Doctor?

Special entitlements apply to services financed from public funds, i.e., services provided by facilities having an appropriate contract with the NFZ. If the patient uses a commercial service, the rules for setting dates are different. In the case of services financed by the NFZ, the facility should take into account the patient’s special entitlement.

Does the Clinic Not Respect the Right to Out-of-Turn Visits? The Patient Can Intervene

If the patient believes that the facility did not take their entitlement into account, they can first contact the management of the service provider. Regarding the implementation of services financed from public funds, you can also contact the appropriate branch of the National Health Fund. Help and information regarding patient rights can also be obtained from the Patient Ombudsman.

Severe Disability: These Entitlements Can Be Used in the NFZ

Having a severe disability can mean much more than the ability to schedule a visit faster. The patient may have the right to:

Copyrighted material – all rights reserved.

Further dissemination of the article with the publisher’s consent INFOR PL S.A. Buy a license.

Enter the e-mail address of the selected person, and we will send them free access to this article