How to Choose a Doctor and Healthcare Provider in Slovakia: Contracted and Non-Contracted Providers

What is a contracted healthcare provider?

A contracted healthcare provider is a doctor, clinic or hospital that has an agreement with a health insurance company.

Under public health insurance, an insured person can generally receive covered healthcare from a contracted provider within the scope of services paid for by public health insurance. However, certain legal fees, additional charges or services outside the public insurance system may still have to be paid.

A contract is not necessarily valid with every health insurance company. A doctor may have an agreement with only some insurers.

For this reason, it is not enough to know that a clinic is "contracted". You should confirm that it has a contract with your specific health insurance company.

What is a non-contracted provider?

A non-contracted provider does not have an agreement with the patient's health insurance company.

In this situation, the doctor or healthcare facility may require:

• ·payment of the full treatment cost,
• ·payment in advance,
• ·a separate examination fee,
• ·payment for administrative or additional services.

Under public health insurance, treatment at a non-contracted provider may not automatically be reimbursed in full. The result depends on the type of treatment, applicable rules and the conditions of the health insurance company.

For commercial health insurance for foreigners, the insurance contract is decisive. Some products may require the insured person to use a contracted provider or obtain prior approval.

Why should you check the doctor in advance?

Before visiting a doctor, check:

• ·whether the clinic has a contract with your insurer,
• ·whether the doctor is accepting new patients,
• ·whether an appointment is required,
• ·whether the doctor speaks a language you understand,
• ·whether a referral is needed,
• ·whether you will have to pay,
• ·whether the clinic cooperates with your commercial insurer.

Not every doctor has contracts with every insurance company. If you visit a provider without checking these details, you may face unexpected costs or difficulties with reimbursement.

Contracted doctors under public health insurance

If you are publicly insured in Slovakia, your health insurance company can provide information about:

• ·general practitioners,
• ·paediatricians,
• ·specialists,
• ·hospitals,
• ·emergency facilities,
• ·available healthcare services.

When choosing a doctor, check whether the provider offers the type of care you need and whether the doctor has a contract with your insurer.

Even a contracted doctor may charge for certain services, such as:

• ·certificates for an employer,
• ·medical examinations for special purposes,
• ·administrative services,
• ·examinations requested by the patient,
• ·above-standard services,
• ·treatment not covered by public health insurance.

Contracted providers under commercial health insurance

Commercial health insurance may work differently from public health insurance.

An insurer may have its own network of contracted clinics, doctors and hospitals. The insured person may be required to:

1. ·contact the assistance service,
2. ·report the medical problem,
3. ·receive a recommendation for a specific provider,
4. ·present an insurance card or policy number,
5. ·receive treatment at the recommended facility.

If a patient visits a non-contracted clinic without prior approval, the insurer may:

• ·refuse reimbursement,
• ·reimburse only part of the cost,
• ·request additional documents,
• ·assess the claim according to the policy limits.

Therefore, with commercial insurance, it is important to know not only the insurer's name but also the required procedure for visiting a doctor.

Do I always have to visit a contracted doctor?

Not always. The answer depends on the type of insurance and the specific policy terms.

In a life-threatening or serious situation, the priority is to seek necessary medical assistance. Administrative questions about the provider can be dealt with afterwards.

For planned or non-urgent treatment, however, it is advisable to check the provider before the appointment. This can help prevent unexpected costs or reimbursement problems.

What should you do if you have already paid for treatment?

If you have paid for medical care, ask for:

• ·a medical report,
• ·an invoice or receipt,
• ·proof of payment,
• ·an itemised list of services,
• ·a prescription,
• ·examination results,
• ·recommendations for further treatment.

Then contact your insurer and ask whether you can submit a reimbursement claim.

Reimbursement is not always automatic. The insurer may assess:

• ·whether the provider was eligible,
• ·whether the treatment was medically necessary,
• ·whether the required assistance procedure was followed,
• ·whether the insurance limit was exceeded,
• ·whether the treatment is excluded under the policy.

Common mistakes

Foreigners often:

• ·visit the first available clinic without checking the contract,
• ·assume that every doctor is contracted,
• ·do not know which insurers the clinic works with,
• ·fail to contact the assistance service,
• ·forget to request an invoice and medical report,
• ·pay for a service that could have been covered,
• ·confuse commercial insurance with public health insurance,
• ·fail to check whether a referral is required.

Practical procedure before visiting a doctor

Before making an appointment:

1. ·Check that your insurance is valid.
2. ·Determine whether you have public or commercial insurance.
3. ·Confirm that the doctor has a contract with your insurer.
4. ·Contact the assistance service if you have commercial insurance.
5. ·Check whether a referral is required.
6. ·Ask about possible fees.
7. ·Prepare your insurance card and identification.
8. ·Keep all documents after the appointment.

Checklist

• ·☐ I know which insurer I am registered with.
• ·☐ I have checked whether the doctor has a contract with my insurer.
• ·☐ I know whether I need a referral.
• ·☐ I have contacted the assistance service if required.
• ·☐ I have checked possible fees.
• ·☐ I have my insurance card and identification.
• ·☐ I have requested a medical report and proof of payment.
• ·☐ I know where to submit documents for reimbursement.

Conclusion

Choosing the right doctor or healthcare provider can significantly affect both the treatment process and its cost. A contracted provider may be more convenient, but you should always confirm that the provider has a contract with your specific insurer and that the treatment is covered.

With commercial health insurance for foreigners, it is advisable to contact the assistance service before visiting a doctor and follow the insurer's instructions.

More information and the option to arrange health insurance are available at Klido.sk.

If you have any questions, contact us at info@klido.sk.