In an effort to protect patients the HSE introduced a system of prior authorisation in respect of inpatient care as allowed for under the Directive. This system of prior authorisation was introduced for the following reasons:
By completing the forms for prior authorisation, the patient will ensure he/she has followed public patient pathways and will be eligible for reimbursement.
By completing the forms the patient will be in possession of the cost of the treatment from the provider abroad and will have been provided with an indication of the anticipated procedure code and thus an indication of the relevant reimbursement rate. (Please be advised that at this stage the reimbursement rate is only indicative as the treatment identified at prior authorisation may not in due course be the actual treatment provided. A patient is only entitled to reimbursement for the treatment he/she actually receives.)
The patient/applicant may submit a fully completed application form accompanied by the appropriate referring letter in sufficient time to allow the HSE assess and make a decision on same. The onus is on the patient to submit a fully completed application form and to provide the necessary information from the referring clinician. Incomplete applications will be returned to the patient/applicant for provision of the appropriate information prior to re-submitting to the CBD office.
