Tuesday, 9 October 2018

Ceisteanna (295)

Robert Troy


295. Deputy Robert Troy asked the Minister for Health the reason administrative staff are changing the code of procedures carried out under the cross-border scheme which is resulting in patients only recovering a percentage of the money they paid (details supplied); and if he will make a statement on the matter. [40919/18]

Amharc ar fhreagra

Freagraí scríofa (Ceist ar Health)

Under the Cross Border Directive (CBD) public patients in Ireland can seek to be referred to another EU/EEA country for a treatment that is available in Ireland. The patient pays for the treatment and claims reimbursement from the HSE at the cost of that treatment in Ireland or the cost of it abroad, whichever is the lesser.

It is important to note that reimbursement is confined to the costs of the care itself and that the rates of reimbursement cannot exceed the cost of the provision of the care if it were provided in the Irish public health service.

The HSE has an obligation to check and verify the details of any payments it makes including applications for reimbursement under the Directive. In carrying out due diligence on applications for reimbursement under the Directive the HSE may examine the details of the treatment received to ensure that the treatment claimed for, and the clinical details of the treatment supplied on the application, are consistent with the procedure code which has been supplied. If there is a discrepancy the HSE will query the details in the application and this may lead to an adjustment of the reimbursement based the details of the treatment received.