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1. What is cross-border healthcare?
2. What is the Cross-border Healthcare Directive?
3. What are the reasons for seeking treatment abroad?
4. How do I know if I am entitled to receive a specific treatment?
5. What is a National Contact Point?
6. Do I need a referral from a doctor in my own country?
7. Do I need prior authorisation?
8. Can prior authorisation be refused? How long does it take?
9. How much will I be reimbursed after receiving treatment abroad?
10. How does the payment process work?
11. What if I have no money to pay up-front for my treatment?
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What Is Cross-border Healthcare?
Cross-border healthcare simply refers to travelling abroad in order to receive healthcare. It is not the same as “falling sick” or having an accident abroad and therefore needing to receive treatment in a different country. Instead, it refers to a conscious decision to travel to another country in order to receive treatment.
If you live close to a border with another country, then receiving cross-border healthcare could involve driving for a few miles, and crossing an international border. It could mean somebody flying, or taking the train for several hours. It could even involve going online and receiving healthcare via telemedicine from a doctor or healthcare professional in another country.
2. What Is the Cross-border Healthcare Directive?
The “Patients’ Rights in Cross-border Healthcare Directive” is a law passed by the EU in 2011 affecting every EU member state plus Iceland, Norway and Liechtenstein. It gives an EU or EEA citizen the right to travel to any other member state and claim some or all of the cost of healthcare treatment from their national healthcare provider if they satisfy certain conditions. The basic principle underpinning the directive is ‘if you are entitled to it here, you can get it there.
In effect, it can make Smarmore Castle Private Clinic more accessible and affordable to EU/EEA patients seeking treatment here, who may be able to claim reimbursement for the cost of treatment from their home healthcare providers.
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3. What Are the Reasons for Seeking Treatment Abroad?
Generally speaking, most people would prefer to receive treatment in their home country. However, there are many reasons that somebody might seek treatment abroad. For example, you may be on a waiting list in your home country, your nearest hospital may be across a border, or you want to travel back to your country of origin to get treatment. You may want to travel to Smarmore Castle for its high standards, level of psychiatric care and excellent reputation. Or the treatment available at Smarmore Castle may not be on offer in your home country, and travelling to Ireland is the only way you can access it.
The Directive makes it clear in recital 39 that personal preference is a sufficient reason to seek treatment abroad and claim reimbursement, but you can include more information in the application to your healthcare provider by giving specific reasons why you want to travel to Smarmore Castle. This is particularly relevant in cases where prior authorisation (see below) is required.
4. How Do I Know if I Am Entitled To Receive a Specific Treatment?
If the healthcare that you are seeking abroad “corresponds to benefits provided for” in your home country, and if the treatment is part of the “basket of care” of provisions in your home country, then you are most likely entitled to the treatment. Provided a medical doctor assesses you as needing this treatment, then you can access this treatment abroad.
An example of a “basket of care” provision- you have an addiction problem and want treatment for it. In your home country, inpatient treatment is provided, but nowhere offers the same treatment method used at Smarmore Castle. You can choose to travel to Smarmore Castle to receive treatment following our method because it ‘corresponds to benefits provided for’ i.e. your home country does provide a form of inpatient treatment for addiction.
5. What Is a National Contact Point?
To help make the process of travelling abroad for healthcare easier, the Directive requires each state to set up a National Contact Point (NCP). These NCPs have been created to provide patients with information about their entitlements to healthcare abroad. They can also help with the administrative process involved in seeking reimbursement as well as rates of reimbursement for specific treatments. In case your application for reimbursement is turned down they can provide you with the appeals procedure. NCPs also supply information about the standards and types of treatment available in their corresponding country, including a list of recognised healthcare providers.
If you are thinking of getting treated at Smarmore Castle, you should contact the NCP in your home country to find out details of the reimbursement rates and procedure in relation to addiction treatment and detoxification. Underneath are the links to all the NCPs available:
*Liechtenstein is not yet obliged to create an NCP and has provided no information about it.
6. Do I Need a Referral From a Doctor in My Own Country?
To obtain cross-border treatment, you only need a referral from an EU/EEA clinician- in certain cases, some countries do request that you involve a GP or specialist from your local area but this is not a typical requirement. For the purposes of Smarmore Castle’s own admissions procedure, we may request contact with your home GP or consultant.
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7. Do I Need Prior Authorisation?
The Directive gives member states the option of implementing a system of prior authorisation for certain treatments. This may mean that the patient has to get official approval for the healthcare they seek prior to travelling abroad for it. Each country in the EU / EEA can establish which treatments are subject to prior authorisation. If you live in a country where prior authorisation is required for inpatient addiction treatment, then you must contact your NCP to begin the process of obtaining prior authorisation.
A system of prior authorisation can only be implemented by an EU/EEA member state if treatment involves an overnight stay in a hospital or requires highly specialised equipment. Most countries have chosen to implement prior authorisation for overnight and highly complex treatment. A few countries such as Sweden, England and Holland do not require prior approval for overnight stays in a hospital.
If you want to come to Smarmore Castle, please check with us and with your NCP to see if you need authorisation from your healthcare provider.
8. Can Prior Authorisation Be Refused? How Long Does It Take?
National health authorities can refuse prior authorisation, and will not reimburse you, under four conditions. The pertinent one for Smarmore Castle is whether the healthcare in question can be provided at home within a medically justifiable time limit. However, the health authority in your home country will need to explain why such a decision is necessary and will need to base their assessment on what is medically justifiable in your individual case.
In case of a refusal, every EU citizen has a right to appeal that decision. If your appeal is unsuccessful then each EU state will have an independent ombudsman (an official adjudicator). If evidence can be provided of a citizen being denied their rights under the Directive, then any EU citizen can make a complaint directly to the European Commission.
Most countries will guarantee a decision about a prior authorisation within 20 days. If there was a degree of urgency and/or the patient’s condition was deteriorating then they would be justified in asking for their case to be fast-tracked.
9. How Much Will I Be Reimbursed After Receiving Treatment Abroad?
Patients will be reimbursed the same amount as the same type of healthcare would cost in their own country. If the treatment is more expensive in the state they are visiting, the patient will need to pay the difference. Member States, where care is free at the point of use, will need to inform patients about their reimbursement tariffs. If the treatment abroad is cheaper than in the home country, the reimbursement will reflect the real price charged by the provider- patients cannot profit from the treatment.
10. How Does the Payment Process Work?
Direct payment to the healthcare provider will usually be settled directly by the patients themselves, either prior to, during or immediately after treatment. The patient will then reclaim the cost of the treatment, up to the amount authorised, from their home healthcare provider.
11. What if I Have No Money To Pay Up-front for My Treatment?
When you have no funds available yourself, you can ask for a family member or friend or other third party such as a credit union or charity to help you with the payments for treatment. If you have acquired prior authorisation, you will be guaranteed reimbursement up to the authorised amount, so borrowing money to pay for the treatment may be a viable option.
The Directive also creates the option for healthcare funders to pay treatment providers directly. This option may not be offered to you, and you may have to specifically request it and explain why you need it.
Even though the Directive makes provision for direct payment, the final choice is up to the treatment funder in the home country. For example, in Scotland, the NHS are willing to make payments directly to treatment providers. However, the NHS in England and Wales will usually not make payments directly to providers, although this stance is being challenged.
12. What Obstacles Do I Face?
Unfortunately, there have been various obstacles placed in the way of this Directive. Some of the most common ones you may face if you want to take advantage of the reimbursement scheme:
- Prior authorisation rules have been made more stringent- for example, requiring referrals from doctors in the country of origin. This administrative burden has been imposed by some countries despite the Directive stating that any EEA clinician would suffice. The clinicians in these countries may be unwilling to refer patients for a number of reasons, so the obstacles faced by the patient are increased. The EU Commission has questioned whether this practice by member states is appropriate in their 2015 report on the Directive’s implementation.
- Requiring patients to justify why they want to travel to another country and receive the treatment. This is contrary to one of the core foundations for the Directive, that patients can choose freely where they want to be treated. Where this occurs, the authority needs to be made aware that they may only introduce administrative burdens where they do not pose an obstacle to the free movement of people. Attention should also be brought to recital 39, which demonstrates the breadth of reasons patients may wish to travel for healthcare, and that should not have to be justified to the national provider.
- Inappropriate remuneration tariffs may be offered by the healthcare provider. Castle Craig offers a unique service in Europe, akin to hospital care, but the reimbursement offered may be based on outpatient care, and therefore substantially lower.
- The failure of countries to pay directly for healthcare. Most countries refuse to take advantage of this option provided in the Directive, forcing patients to pay upfront instead. This can cause hardship to many patients and is contrary to the spirit of the Directive. In cases of these blanket bans, the consequence of people being forced to stay in their own country for treatment may even pose an obstacle to the EU’s fundamental right to free movement.