There is a long wait for a medical procedure that I need. Can I get my medical costs refunded if I have the procedure done in another European country?
Answer (December 2017)
If you are entitled to public health services that are available in Ireland, you can access these services in the European Economic Area (EEA). You will be repaid the cost if you meet the requirements.
This is provided for by the Cross-Border Healthcare Directive. The Directive covers services that are publicly funded and available in Ireland. These include acute hospital services and community-based outpatient care. Other services covered include physiotherapy, ophthalmic, psychology, disability and mental health services. Occupational therapy services and dental and orthodontic services are also covered, but with some exceptions. The Directive doesn’t cover treatments that qualify for the Treatment Abroad Scheme (in general, treatments that are not available in Ireland).
You must be referred to the health service abroad in the same way that you would be referred to public health services in Ireland. This referral may be by your GP (family doctor) or public hospital consultant, for example. They may also be able to tell you whether the service you require is covered by the Directive. You can also check with the National Contact Point (details below).
If the treatment involves an overnight stay in hospital, it will need to be authorised in advance by the Health Service Executive (HSE). For other treatments, you should check whether prior authorisation is required. You pay the costs of treatment and then apply for a refund when you return to Ireland. The amount repaid is either the amount that the treatment would cost in Ireland, or the cost of your treatment abroad, if that is less. It does not include other costs such as travel. The HSE has published refund amounts for different treatments. To get a refund of treatment costs, you and your healthcare provider abroad must complete a HSE form. You then submit it with the healthcare provider invoice and receipt. The HSE provides an invoice format that it recommends using for the invoice to make sure it includes all the required details.
To find out more, contact the National Contact Point: phone (056) 778 4546 or email email@example.com.