Possibility for the HSE cost refund for treatment abroad

If you are a permanent Resident of Ireland and are struggling with long waiting times for your planned surgery (for example a hip replacement or a total knee replacement), there is an official way to plan your operation in a private hospital in one of the European Union countries and claim the reimbursement from the HSE. The whole process is called the Cross Border Directive Scheme (CBD) and in this article, we are trying to divide it in steps, to make it easy and understandable.

How to plan my treatment abroad with the HSE refund?

The first step to ask yourself when considering the surgery abroad with the HSE refund is to answer the following questions:

• Is the treatment (surgery) I need available in Ireland under the public healthcare system?
• Am I the ordinarily resident of Ireland? (*You need to live in Ireland, pay bills – sometimes you are asked to show utility bills -and you intend to live in Ireland for at least 1 year)
• Am I entitled to public healthcare in Ireland?
• Do I qualify for healthcare as a public patient in Ireland?
• Do I have a valid referral letter from the Irish Doctor (from a public GP or public consultant)?
• Do I have enough money to pay for my treatment abroad + travel expenses out of my pocket? (*treatment costs are refunded after the treatment is completed, you are back in Ireland, and apply. It may take approximately 3 months)

If “yes” are all your answers, there is a high chance that you could start preparations for the Cross Boarder Healthcare process.

Since your treatment abroad will include an overnight stay in the hospital (which is most likely in orthopaedic surgeries) we strongly recommend applying for the PRIOR NOTIFICATION (prior approval). It gives the peace of mind, that the HSE has reviewed some of your documents, and that you are eligible to claim a reimbursement towards the cost of your healthcare. You will also learn how much you can claim.

Two steps to plan your treatment abroad and ensure you can claim the HSE reimbursement for your treatment:

Step 1: VALID REFERRAL for a treatment abroad cost refund from the HSE

Let’s start with checking if the referral you possess is valid and sufficient for the next steps in planning your surgery abroad and applying for the HSE cost refund.

If you don’t have a referral, in some cases you may also use a waiting list letter, however then we suggest contacting the HSE Cross Boarder Department. : 056 778 4547

Your referral letter must include:

• the name and address of a hospital consultant or your GP
• your name, address and date of birth
• a summary of your condition and any diagnosis, if known
• the healthcare you need (so said exactly, for example: “a total left knee replacement surgery”
• the GP or clinical referrer’s signature – it cannot be signed by their nurse or secretary
• the date of the referral letter – the letter must be issued before your first appointment abroad
• You do not have to use the consultant and hospital named in the referral letter. But your healthcare abroad must be the same medical speciality on your referral letter.

Step 2: PRIOR NOTIFICATION for a treatment abroad cost refund from the HSE

Having a valid referral letter will allow you to plan the next step, which is planning a consultation with a chosen healthcare specialist abroad.

*We would recommend checking with the CBD if they will accept your referral: crossborderdirective@hse.ie

To get prior notification, you must prepare the following documents:

• your valid referral letter
• a completed prior notification form (we will help you with filling it out)
  https://assets.hse.ie/media/documents/cbd-prior-notification-form_06032023.pdf
• proof that you travelled abroad to have your first appointment with the consultant in person
• invoice, receipt and proof of payment for your first appointment such as a bank or credit card statement or bank transfer

Just in case, check the latest form version here:

https://www2.hse.ie/services/schemes-allowances/cross-border-directive/before-you-go-abroad/

Consultation with the operating surgeon

If you would like to undergo your surgery in Poland, it means you would need to schedule a consultation with the operating surgeon in person.  It may seem like an obstacle, however we encourage you to treat it as a possibility to meet your Doctor, speak about your condition, see the facility.

• You complete section A of the form.
• Your consultant completes section B.

We will be happy to help you in the arrangements, finding the most convenient date, research flights, fill out the necessary forms. Please collect all the receipts from your travel day, and stay in the hospital. Your flight tickets, receipt of payment in the hospital, bills for a coffee at the airport etc.

You can fly in to Katowice with the morning flight, have a consultation with X-rays, and depart in the evening. We are located 30 minutes away by taxi from the Airport.

Sending the Prior Notification Request

When you come back, and send the completed form, referral, proof of travel and invoice for the consultation to the HSE, usually it takes about 20 working days to review and decide on your prior notification.

Send the completed form and the supporting documents to:

HSE Cross Border Directive,

National Contact Point,

St. Canice’s Hospital Complex,

Dublin Road,

Kilkenny

Step 3: Treatment and applying for the cost refund abroad to the HSE

We will be happy to help you plan your treatment. Together with you and the hospital’s planning team we will agree on the dates, pre-book them, discuss the necessities you need to pack, and plan your airport pick-up.

Please keep in mind, that HSE will not refund you the travel expenses, just the treatment, but we will be happy to help you find the most affordable flights.

If you would like to bring a Family member with you, this person can stay in the hospital room with you, however, the HSE can not refund this stay, so you would need to cover it out of your pocket.

During the hospital discharge, you will receive the invoice for your surgery, and discharge letter – all in English, so it’s easier to submit it.

You would need to submit several documents, among others, the CBD PRO FORMA INVOICE

https://assets.hse.ie/media/documents/cbd-pro-forma-invoice_06032023.pdf

• You complete section A of the form.
• Your consultant completes section B.

You must send:

• completed CBD pro forma invoice https://assets.hse.ie/media/documents/cbd-pro-forma-invoice_06032023.pdf where you complete section A of the form and Your consultant completes section B
• hospital’s original invoice and receipt
• referral letter from the GP or public consultant who referred you in Ireland (the one you have from before the first visit)
• proof of travel such as a plane ticket receipt – this is to show you travelled abroad for your healthcare
• proof of direct payment to the hospital abroad such as a bank or credit card statement or bank transfer (EFT)

Other examples of proof of payment include:

• cash register receipt
• credit or debit card receipt
• copy of the electronic fund transfer (EFT) from your account to the account of the hospital abroad
• copy of the bank draft paid to the hospital abroad

Please note that at the moment, it takes a minimum 2-3 months for the HSE to send you the money.

If you used a different currency than the Euro to pay for your healthcare, you can claim a reimbursement based on the exchange rate you were given at the time.

You must include proof of the exchange rate in your application such as a bank statement or a currency exchange receipt.

How much I can claim from the HSE for my surgery abroad?

There is a maximum quote which you can claim from the HSE, however if you have paid less than stated, the smaller amount will be refunded. Please find some of the examples below:

• I04B KNEE REPLACEMENT €11,705
• I03B HIP REPLACEMENT €11,422
• I09C SPINAL FUSION €13,751
• I24B ARTHROSCOPY €3,484

It allows you to refund almost all costs of your hip replacement or a knee replacement in Poland. The only costs you would need to cover yourself would be travel expenses (flight tickets) and prior consultation.

If you are interested in the process, please feel free to contact us. We will do our best to help.

 

 

Sources:
https://www2.hse.ie/services/schemes-allowances/cross-border-directive/how-to-get/
https://www2.hse.ie/services/schemes-allowances/cross-border-directive/contact/
https://www2.hse.ie/services/schemes-allowances/cross-border-directive/before-you-go-abroad/
https://www2.hse.ie/services/schemes-allowances/cross-border-directive/using-a-referral/
https://eurotreatmed.co.uk/treatments/orthopaedics/total-hip-replacement/