Bedridden patients are entitled to 12 house calls from a general doctor a year under revamped rules, Gesy (general health system) clarified on Friday.
In an FAQ on house calls under Gesy, who qualifies and what is covered, it said that this service had been incorporated into the system in December.
Access is conditional on a referral from the personal or specialist doctor and concerns beneficiaries who have been classified as bedridden by their personal doctor.
In such cases, beneficiaries have the right to choose from the list of providers participating in Gesy and to make an appointment.
Gesy covers a maximum number of such calls for general medicine per beneficiary as follows:
All patients (children and adults) are allowed up to 12 visits that are covered by the system. In exceptional cases where the doctor and nurse deem that the patient needs more visits, they can submit a request which will be evaluated by the state health services organisation (Okypy), once all the necessary information and documentation has been submitted.
Every new year, a beneficiary will be entitled up to 12 visits provided the preconditions for which Gesy renumerates the house calls are satisfied.
The medical devices or consumables required by every beneficiary for their home care are prescribed by the doctor. They can either be obtained from hospital pharmacies (or hospital storerooms) or private pharmacies. In the latter case, they bear the label «ΙΦ».
In cases where the beneficiary or relative cannot obtain the required items and provided there is the relevant authorization, the system allows a medical professional to obtain them on behalf of the beneficiary. In such cases, the medical professional must obtain authorization from the beneficiary and must give the pharmacy the personal data of the beneficiary, such as the ID number of date of birth.
Q: Can a beneficiary obtain the service outside Gesy from a medical professional who has a contract with Gesy?
A: In cases where the beneficiary does not have or does not submit a referral with services covered by Gesy, then the medical professional can offer their services, but these will not be paid by the system. They must inform the beneficiary from the start that the services are outside the system. The same applies if the beneficiary has used up the maximum number of visits allowed.
Q: Can beneficiaries receive services over the weekend?
A: Okypy does not stipulate the days/hours of work of each provider. In such cases however, the provider must comply with the rules as regards the total duration of services so as to ensure quality care.
Q: Can a beneficiary admitted to a hospital that does not have an agreement with the Health Insurance Organisation receive the services of a medical professional with a contract with Gesy?
A: If the patient does not have a referral for hospital care, then the medical professional can continue to offer their services outside Gesy, with the beneficiary covering the cost.
If the services are provided during admission of a beneficiary at a hospital that is contracted with Gesy then these services are covered by the system.