STORY: Read about how the right to treatment works in practice
Seeking treatment with prior authorisation
Leena’s twin pregnancy care in Germany
Leena is expecting twins, and her pregnancy requires treatment that is not available in Finland. Her doctor in the Wellbeing Services County of North Ostrobothnia has found out that the treatment is available at a hospital in Hamburg.
Leena applies for prior authorisation from Kela for treatment in Germany, enclosing a public health care statement she received from her doctor. Kela grants the prior authorisation, since public health care has recommended it. Kela provides Leena with form S2, which she must give to the treatment provider in Hamburg.
Leena travels to Hamburg and receives the necessary treatment. She pays the local client fee for the treatment. The rest of the German health care costs are paid by Kela, which then charges them from the Wellbeing Services County of North Ostrobothnia.
After receiving the treatment, Leena claims reimbursement from Kela for travel, medication and accommodation costs incurred during the trip, which she initially paid herself. She claims the reimbursement within six months using form SV 128.
Grounds for Leena’s right to treatment
Leena may apply for prior authorisation from Kela for treatment that is provided in another EU or EEA country, United Kingdom or in Switzerland. Prior authorisation is a payment commitment on the basis of which Leena’s municipality of residence is responsible for the costs of treatment provided abroad.
For the prior authorisation decision, Kela always requires a statement from the public health care unit responsible for the patient’s treatment. Kela must grant prior authorisation if the statement recommends it. In order to receive prior authorisation, Leena’s need for treatment must be medically justified and she must be entitled to the treatment in question in Finnish public health care, but the public health care provider cannot arrange for treatment within a medically justifiable time period. Public health care may also consider granting the authorisation in other situations, such as for language reasons.
In Leena’s case, she received a statement recommending prior authorisation from her own wellbeing services county and enclosed it with her application. Since Kela has provided Leena with prior authorisation for treatment, she may also receive retroactive reimbursement from Kela for costs of travel, medication, accommodation and an accompanying person. For treatment received with prior authorisation, Kela will reimburse travel costs to the treatment facility.