Seriously ill patients who travel abroad for much-needed treatment can be exposed to unnecessary expense and upset due to shortcomings in the way the HSE handles requests for financial assistance.
Confusion around how certain reimbursement schemes operate adds to the negative patient experience, according to Ombudsman Peter Tyndall. He has published a series of complaints sent to his office to heighten awareness of the schemes.
Mr Tyndall said the lheme (CBH) was a particular area of confusion. People tended to confuse it with the treatment abroad scheme (TAS) which is restricted to covering treatments not available here. The CBHC scheme, on the other hand, gives people resident in Ireland the option of having public health treatment in another EU country, whether it’s available here or not. Both schemes are administered by the HSE.
Mr Tyndall said he had received complaints from people confused about how the scheme operates or who had difficulties trying to reclaim costs: “Very often they are vulnerable people who are seriously ill and who have had to travel outside the country to receive much needed medical treatment.”
One of the complaints involved a woman who had previously been approved under TAS for in-patient lymphoedema treatment (to control swelling of her legs following cancer treatment), but was initially refused further treatment under that scheme.
Mr Tyndall said she was then “incorrectly advised” to apply for treatment under the CBH scheme.
“According to the HSE, the treatment she needed was available on an out-patient basis in Ireland. This was incorrect.”
He said while out-patient care was available here for some lymphoedema patients, the woman required a more intensive form of in-patient treatment unavailable here. Therefore, her application should have been considered under the TAS.
After paying in advance for her treatment abroad under the CBH, she was advised by the HSE that she needed to submit a “treating code”. However, there are no HSE treating codes for out-patient care abroad.
“In desperation, the woman turned to her private healthcare which provided a contribution towards the costs,” said Mr Tyndall.
After she complained to the Ombudsman, the HSE agreed to refund the balance to her (€2,900), to also approve future lymphoedema treatment for her under the TAS, and to consider applications for other patients in a similar situation.
The HSE said yesterday that it is “currently reviewing the information provided to the public” on the CBH scheme “and will take the Ombudsman’s comments into consideration”.
A European Commission report on CBH use in the EU, published in October, shows Ireland received 4,599 requests for information about the scheme in 2015 and 216 requests for authorisation to travel, of which 93 were authorised, 15 refused and 85 withdrawn or inadmissible.
Ireland reimbursed €448,458 under requests for prior authorisation.
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