Surgery abroad

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krapulassa
Posts: 10
Joined: Thu Sep 03, 2020 8:23 pm

Surgery abroad

Post by krapulassa » Thu Sep 10, 2020 4:34 pm

Hi, I need to have a surgery performed on me by my doctor in Estonia.

Kela pays for such surgeries abroad if they are covered by the public healthcare system in Finland.

Can someone tell me if there is an online list of surgical operations that are covered by the Finland healthcare system so I can figure out if this surgery will be covered in Estonia?



Surgery abroad

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inkku
Posts: 794
Joined: Wed Apr 04, 2007 8:26 pm

Re: Surgery abroad

Post by inkku » Thu Sep 10, 2020 5:15 pm

krapulassa wrote:
Thu Sep 10, 2020 4:34 pm
Kela pays for such surgeries abroad if they are covered by the public healthcare system in Finland.
Is it? what is your source?

To my knowledge, the need for surgery is determined by your doctor in Finland. So you go to see the doctor in Finland. if you live in Estonia, you are taken care by the Estonian healthcare.

betelgeuse
Posts: 3563
Joined: Thu Aug 29, 2013 1:24 am

Re: Surgery abroad

Post by betelgeuse » Thu Sep 10, 2020 6:07 pm

krapulassa wrote:
Thu Sep 10, 2020 4:34 pm
Hi, I need to have a surgery performed on me by my doctor in Estonia.

Kela pays for such surgeries abroad if they are covered by the public healthcare system in Finland.

Can someone tell me if there is an online list of surgical operations that are covered by the Finland healthcare system so I can figure out if this surgery will be covered in Estonia?
” Apply for prior authorisation from Kela on form Authorisation to obtain treatment outside the country of residence (SV 129e).”

https://www.kela.fi/web/en/medical-trea ... ent-abroad

inkku
Posts: 794
Joined: Wed Apr 04, 2007 8:26 pm

Re: Surgery abroad

Post by inkku » Thu Sep 10, 2020 6:22 pm

Interesting betelgeuse, what does that mean in practice?
I presume you don't get full reimbursement because you don't get that in Finland either.
For instance if I go to a private dentist in Finland I only get back a certain percentage of the treatment, not 100%.

betelgeuse
Posts: 3563
Joined: Thu Aug 29, 2013 1:24 am

Re: Surgery abroad

Post by betelgeuse » Thu Sep 10, 2020 6:37 pm

inkku wrote:
Thu Sep 10, 2020 6:22 pm
Interesting betelgeuse, what does that mean in practice?
I presume you don't get full reimbursement because you don't get that in Finland either.
For instance if I go to a private dentist in Finland I only get back a certain percentage of the treatment, not 100%.
” Margit wants to have treatment in Estonia. She has been given prior authorisation (S2) from Kela. Since she has prior authorisation, Margit pays only the local client fee of 35 euros for her treatment in Estonia. The actual cost of the treatment is 13,000 euros. Estonia sends Finland an invoice for the rest of the costs, 12,965 euros. Kela sends the hospital district Margit belongs to an invoice for the costs.”

https://www.kela.fi/web/en/medical-trea ... -your-care

It’s not that hard to read the Kela web pages...

inkku
Posts: 794
Joined: Wed Apr 04, 2007 8:26 pm

Re: Surgery abroad

Post by inkku » Thu Sep 10, 2020 6:45 pm

thanks but you did not reply to my query.
For instance regarding dental treatment, there is no full reimbursement here.
What I am wondering if there is a huge queue here for the treatment, one just travels abroad, gets a private treatment and sends the bill to Kela. Cannot be that easy...? And how come the need is not determined in Finland but abroad.

betelgeuse
Posts: 3563
Joined: Thu Aug 29, 2013 1:24 am

Re: Surgery abroad

Post by betelgeuse » Thu Sep 10, 2020 7:59 pm

inkku wrote:
Thu Sep 10, 2020 6:45 pm
thanks but you did not reply to my query.
I don't understand why not. The example from the Kela page matches exactly the topic of this thread (going to Estonia for treatment).
inkku wrote:
Thu Sep 10, 2020 6:45 pm
For instance regarding dental treatment, there is no full reimbursement here.
What I am wondering if there is a huge queue here for the treatment, one just travels abroad, gets a private treatment and sends the bill to Kela. Cannot be that easy...?
In that case the reimbursement would be under the same rules as in Finland.

"Kela will reimburse retrospectively the costs of treatment given in an EU or EEA country or in Switzerland in the same manner as for private health care given in Finland."

https://www.eu-healthcare.fi/health-ser ... orisation/

The already reference prior authorisation scenario is thus likely to be cheaper.
inkku wrote:
Thu Sep 10, 2020 6:45 pm
And how come the need is not determined in Finland but abroad.
The reasoning is in the recitals of the directive on the application of patients’ rights in cross-border healthcare.

https://eur-lex.europa.eu/legal-content ... 32011L0024

krapulassa
Posts: 10
Joined: Thu Sep 03, 2020 8:23 pm

Re: Surgery abroad

Post by krapulassa » Thu Sep 10, 2020 11:34 pm

betelgeuse wrote:
Thu Sep 10, 2020 6:07 pm
” Apply for prior authorisation from Kela on form Authorisation to obtain treatment outside the country of residence (SV 129e).”

https://www.kela.fi/web/en/medical-trea ... ent-abroad
Yes, I need the list of operations covered in Finland. Only selected few surgeries are paid for abroad. What are those surgeries? Is there a list available online?

heretostay
Posts: 416
Joined: Sat Apr 08, 2017 12:54 pm

Re: Surgery abroad

Post by heretostay » Fri Sep 11, 2020 1:27 am

krapulassa wrote:
Thu Sep 10, 2020 4:34 pm

Can someone tell me if there is an online list of surgical operations that are covered by the Finland healthcare system so I can figure out if this surgery will be covered in Estonia?
This is not how health insurance works, so there is no list of what will be covered even though you often can easily find lists of what won’t be covered. You should try to get prior authorization documentation for your case from kela. That is the only way to know you will be covered for certain.

krapulassa
Posts: 10
Joined: Thu Sep 03, 2020 8:23 pm

Re: Surgery abroad

Post by krapulassa » Fri Sep 11, 2020 1:55 am

heretostay wrote:
Fri Sep 11, 2020 1:27 am

This is not how health insurance works, so there is no list of what will be covered even though you often can easily find lists of what won’t be covered. You should try to get prior authorization documentation for your case from kela. That is the only way to know you will be covered for certain.
Ok so the doctor in Estonia write documents as to what kind of surgery he will perform, I try to pre-authorize it with Kela yes? Is this going to be in English this documentation or it could be in local Estonian language?

heretostay
Posts: 416
Joined: Sat Apr 08, 2017 12:54 pm

Re: Surgery abroad

Post by heretostay » Fri Sep 11, 2020 7:33 am

English would be better.

betelgeuse
Posts: 3563
Joined: Thu Aug 29, 2013 1:24 am

Re: Surgery abroad

Post by betelgeuse » Fri Sep 11, 2020 8:58 am

heretostay wrote:
Fri Sep 11, 2020 1:27 am
krapulassa wrote:
Thu Sep 10, 2020 4:34 pm

Can someone tell me if there is an online list of surgical operations that are covered by the Finland healthcare system so I can figure out if this surgery will be covered in Estonia?
This is not how health insurance works, so there is no list of what will be covered even though you often can easily find lists of what won’t be covered. You should try to get prior authorization documentation for your case from kela. That is the only way to know you will be covered for certain.
Kela does maintain this long list but not being on it doesn’t mean something wouldn’t be covered in the public system.

https://www.kela.fi/documents/10180/0/S ... 77e9bd0307

inkku
Posts: 794
Joined: Wed Apr 04, 2007 8:26 pm

Re: Surgery abroad

Post by inkku » Fri Sep 11, 2020 11:03 am

Thanks betelgeuse, when they say reimburse it gives an impression they are going to cover it full whereas they give the same partial reimbursement as using private medical services in finland. Now it makes sense.


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