Gesundheitsportal
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Cost reimbursement

For the purpose of the Patient Mobility Directive, the following conditions shall be considered with regard to the possible reimbursement of costs.

Cost reimbursement requirements

The commitment to reimburse costs in accordance with Directive 2011/24/EU covers exclusively those health services to which the insured person is entitled under national law. Entitled to reimbursement are only those persons who have received healthcare services in other EU countries against payment (cash, credit card, etc.) of the treatment costs.
To qualify for costreimbursement under the EU patient mobility directive, prior authorisation before undergoing the treatment must be obtained from the Austrian insurance carrier in regard to certain therapies. The respective social health insurance carrier will provide further information.

Under the Directive, the Austrian Social Insurance Institution is not liable to pay any refund, if the requirements for granting prior authorisation for such treatments are not met. In these cases, the treatment costs will thus be entirely borne by the patient.

Level of reimbursement

Basically, the Member State of affiliation shall reimburse the cost of the cross-border healthcare of up to the maximum amounts that would have been accepted, if the healthcare service in question had been provided within its territory. At this, the amount of reimbursement may not exceed the actual costs incurred.

Private practitioners and the hospital sector must be taken into account independently in regard to the exact amount of reimbursement (see Treatment costs).

Hospital sector (inpatient and outpatient treatments):

Granting prior authorisation on the basis of the Patient Mobility Directive (Prior authorisation) will entitle the patient to a “special” reimbursement in the form of the amount that would have been paid had the service been provided by a hospital in Austria.

As a rule, the amount is made up of a percentage calculated via the LKF system (performance-orientated hospital financing system, Austrian DRG model) and a percentage, which is calculated by the respective Landesgesundheitsfond (Austrian regional health fund). The social insurance institution responsible will inform on the exact amount of the expected reimbursement.

If obtaining prior authorisation was omitted, an application for reimbursement under § 150 ASVG (contribution to the cost of medical care) or § 131b ASVG (hospital outpatient services) or by other analogous social insurance regulations can be submitted to the Austrian social insurance carrier responsible later on. The competent social insurance carrier will check whether the requirements for reimbursement are met. The amount of the contribution to the costs of medical care is defined in the regulations of the individual insurance carrier.

The insured person is not entitled to reimbursement, if prior authorisation was not granted, or if in the case of failing to obtain the prior authorisation, the subsequent examination revealed that the requirements for reimbursement were not met.

Private practitioners:

In general, prior authorisation for the utilisation of health services in private practice is not required. In this case, reimbursement will be in accordance with national regulations (80 percent of a contract tariff that would have been paid by the social insurance carrier had this been a domestic affiliate).

However, certain treatments require prior authorisation (prior authorisation). If prior authorisa-tion has been granted, the patient is entitled to “special” reimbursement equal to the amount that the domestic affiliate would have received for the same treatment. The competent social insurance carrier will inform on the exact amount of the expected reimbursement.

If obtaining prior authorisation was omitted, an application for reimbursement in accordance with § 131b ASVG or in accordance with other analogous social insurance regulations can be submitted to the Austrian social insurance carrier responsible. The competent social insurance carrier will then check whether the requirements for reimbursement are met. Reimbursement will be 80 percent of the amount that would have been paid to a relevant contract partner of the Austrian insurance carrier.

The insured person is not entitled to reimbursement, if prior authorisation was not granted, or if in the case of failing to obtain prior authorisation, the subsequent examination revealed that the requirements for reimbursement were not met.

Exception “Medical emergency“

For treatments in the context of a medical emergency occurring during a temporary stay in another EU country, the patient is entitled to all benefits in kind, which prove to be necessary on medical grounds, while taking into account the nature of service and the expected length of stay (“Unplanned treatment”). For more information, see "Medical emergencies".

Contact information of social insurance carriers

The contact information of the respective social insurance carriers can be found here www.sozialversicherung.at

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