Settlement of treatments abroad based on the Order of the Minister of Health no. 50/2004 regarding the methodology for sending certain categories of patients for treatment abroad, amended and supplemented by Order no. 814/2018
If you are diagnosed with a serious illness that is not included in the basic package offered by the Romanian National Health Insurance House and you need funds to pay for a treatment to be performed abroad, you can consult the information presented in the content of this article.
The amounts related to the payment of treatments performed abroad can be reimbursed by the Romanian Ministry of Health based on Order of the Minister of Health no. 50/2004 regarding the methodology for sending certain categories of patients for treatment abroad, amended and supplemented by Order no. 814/2018.
In order to obtain the funds, it is necessary to complete the following steps, either by the patient / a legal representative of the patient or by the relative (spouse, fourth degree relative):
- Only patients suffering from medical conditions that cannot be treated in Romania, that are registered on the list of a family doctor, that have gone through all the levels of medical care, respectively primary health care, and were hospitalized in health facilities that provide medical services of high professional and technical quality, but whose health has not been restored can benefit from medical treatments abroad;
- The patient’s medical documents (hospital discharge ticket, medical letter, results of medical investigations, doctor’s recommendation regarding treatment abroad etc.) are submitted by him, his legal representative or by the relative (spouse, degree IV relative) at the public health directorate in whose territorial area the patient resides, together with a request from him, the legal representative or the owner accompanied by copies of their identity documents;
- For children aged from 0 to 1 year, the required folder to access treatment abroad can be made immediately after being diagnosed in a health facility within a university, without the need for going through all the steps provided for patients from other age categories;
- The file is analyzed by a territorial specialized commission consisting of at least 3 specialized medical staff with a high level of professional training, the president being appointed by order by the Minister of Health, at the proposal of the specialized commissions of the Ministry of Health;
- If a specialized territorial commission from a university center is not functional, the patient’s files from the counties assigned to this commission will be analyzed by the territorial specialized commissions from other university centers, according to the Ministry of Health, until the situation is remedied;
- If the patient or his legal representative expresses his option to contact and maintain communication with the clinics abroad, he will present to the public health directorate official documents issued by the clinics recommended by the territorial specialized commission, with header and signature, which include at least the elements provided by annex no. 10 of the Order no. 50/2004 (https://lege5.ro/Gratuit/gi2tonzsgm/anexa-nr-10-la-ordinul-nr-50-2004-ordin-1011-2011?dp=gu3dinrsgy4dq). Only documents submitted in original or, as the case may be, by fax or e-mail, in scanned form and translated by an authorized translator are considered valid. If the clinic does not submit the treatment offer according to annex no. 10, the submitted document must include at least information regarding the cost of evaluating the patient, the total cost of the treatment to be performed and what it includes, as well as the cost of hospitalization;
- If the number of clinics where the treatment can be performed is limited and the territorial specialized commission recommends a single clinic in the medical report for referral to medical treatment abroad, a single treatment offer will be accepted by the territorial commission, if the choice made is motivated. The commission established at the level of the Ministry of Health can approve the treatment at the recommended clinic, in which case the 3 treatment offers are no longer necessary;
- If the patient or his legal representative requests to follow the treatment at a clinic other than the one recommended by the territorial commission specialized in medical records, this can be possible if the patient ensures from his own funds the difference of costs compared to the offer sent by the clinic for which the approval was received, both for the treatment and for the transport, until the end of the treatment. In this regard, the patient or his relative will sign a declaration on his own responsibility according to which he undertakes to bear all additional costs;
- The costs of medical treatment are provided by the Ministry of Health within the budget approved annually and quarterly and cover the following:
- medical-surgical treatment;
- interventional treatment;
- radiotherapy treatment;
- hospitalization;
- patient transport;
- transport of the companion, for patients aged between 0 and 18 years.
- The budgetary provision for credits distribution shall be drawn up within a maximum of 7 working days from the approval of the file by the chief authorizing officer;
- If the amount invoiced for the treatment is less than that approved, the difference may be used for the same purpose, if necessary, or for carrying out periodic checks, at the request of clinics abroad, during the same calendar year, with the approval the commission of the Ministry of Health;
- If the situation of the patient undergoing treatment abroad worsens and additional interventions are necessary, the commission may approve the continuation of treatment at the clinic abroad, based on a supporting document issued by the clinic representatives, which will include the diagnosis, the type of treatment to be carried out and the costs involved, at the request of the county public health departments and of the municipality of Bucharest.
