Payment of services and health insurance companies
The healthcare facility bABA care, s.r.o. is a contractual partner of the following health insurance companies (HICs) providing public health insurance in the Czech Republic:
- 111 Všeobecná zdravotní pojišťovna ČR
- 201 Vojenská zdravotní pojišťovna ČR
- 205 Česká průmyslová zdravotní pojišťovna
- 207 Oborová zdravotní poj. zam. bank, poj. a stav.
- 209 Zaměstnanecká pojišťovna Škoda
- 211 Zdravotní pojišťovna ministerstva vnitra ČR
We also have a contract for the payment of health care with VZP a.s. (code 333), which is a commercial insurance company providing health insurance to foreigners without permanent residence in the Czech Republic. The payments of this insurance company are at the same level as public health insurance.
The contractual facility is obliged to provide health services to participants of public health insurance "free of charge", more precisely, exclusively for payment by the health insurance company without financial participation of the patient.
About our services
Clients of our facility who have public health insurance in the Czech Republic can choose whether to use only the services covered by the health insurance company, or whether they want to pay extra for services that are not covered, but we consider beneficial. It is important to remember that the spectrum of services covered by health insurance companies reflects the state of medical science at the time of the creation of these "tariffs", i.e. at the beginning of the 1990s of the last century. For example, the so-called bimanual palpation examination in gynecological prevention is practically diagnostically worthless from today's perspective. Preventive ultrasound examination of the pelvic organs, which is the only one that can detect, for example, the incipient stages of malignant ovarian tumors, is not covered by public health insurance. The same is true of many procedures in the care of pregnant women: palpation of the vagina, which is part of prenatal care, is also completely outdated and unnecessary, if not harmful, covered by the so-called Second-trimester biochemical screening for birth defects has been considered completely obsolete for many years. Ultrasound examination is only covered 3 times during the entire pregnancy, so first-trimester combined screening and ultrasound cervicometry (i.e. objective measurement of the length of the cervix), measurement of placental flow, etc. are completely excluded from reimbursement.
Furthermore, it is necessary to realize that the main requirement for providing health services on behalf of public health insurance is strict expediency and especially economy. The ideal is certainly an empathetic doctor who listens patiently to his patient, then explains everything clearly, answers all his questions, so that he can make an informed decision about possible treatment options. The public health system, to be honest, does not really support such an ideal; outpatient specialists (and the public usually does not know this) are paid for the procedure. Therefore, when a patient comes to talk about his health and seek advice, the medical facility receives nothing, because no procedure was performed. There are items in the price list called EDUCATIONAL INTERVIEW OF A DOCTOR WITH A PATIENT OR FAMILY (09523) and INTERVIEW OF A DOCTOR WITH A FAMILY (09525), but insurance companies are very reluctant to allow them to healthcare providers. It is understandable: doctors would then talk to patients for money and the work would cost... (By the way, even if the health insurance company "contracts" it to a provider, the tariff is about 500 CZK/hour gross and try talking to a lawyer for five hundred per hour. That would be very cheap.) We do not have a contract for these interviews and conversations with any insurance company, so we charge them as a consultation.
In the previous paragraph, I came across another important fact: just because something is covered by a health insurance company does not mean that the insurance company will pay anyone for it. It will only pay for services that the provider has "contracted" with a certain insurance company. Many of the contracted procedures are also limited in frequency; i.e. it is determined how many times a doctor can perform the procedure in a certain period of time (or he can perform it as many times as he wants; the limitation says how many times the insurance company will pay for it). By the way, if you would like to read more about the financing of outpatient specialists, click here.
So how is it with us? We have a contract with insurance companies for routine procedures, but we do not have a contract for a number of those that we are able to perform. Example: a preventive examination is covered by the insurance company, but we consider it appropriate to supplement it with a preventive ultrasound examination of the pelvic organs (790 CZK), which is not covered in this indication. The same is true for pregnant women. Because teaching them would be difficult, we offer two programs: the STANDARD program, which does not include first-trimester ultrasound screening and other additional examinations, so we only do what the insurance company covers. The second option is the COMFORT program with flat-rate surcharges (entrance fee 1200,- and then 650,- for each visit; there are about 6-7 of them for the entire pregnancy). For this flat-rate fee, we will do everything that is possible (or what we consider to be expedient or what the patient wishes), ultrasound and fetal photography at each visit (if conditions allow), ultrasound measurement of the length of the cervix, measurement of placental flow, all examinations and samples, including the so-called glucose tolerance test, will then be performed at our place as part of the pregnancy consultation and we do not send patients anywhere. On the contrary, we do not do what we do not consider necessary, we do not take pregnant women unnecessarily often, unless it has a medical benefit (for example, just to get the appropriate reimbursement from the health insurance company).
Entry into the COMFORT program is completely voluntary for pregnant women. Since most of our patients visit us in the COMFORT mode, we ask those who wish to receive care in the standard mode (exclusively for reimbursement by the health insurance company) to inform us in advance.
Foreigners, clients of commercial insurance companies with whom we do not have a contract for the provision and reimbursement of health care (Maxima, Unica), will pay for the care by direct payment (in cash or by credit card), and will receive a confirmation and a schedule of services,possibly also a medical report. With these documents, he can then claim compensation from his insurance company.