0232 233 387 info@consultmed.ro

 

MEDICAL SERVICES PACKAGE IN OFFSET SPECIALTY MEDICAL ASSISTANCE FOR CLINICAL SPECIALTIES

Basic package of services
NAME OF THE MEDICAL SERVICE FREQUENCY / MAXIMUM
c1 c2
1.  Medical services for emergency medical-surgical situations 1 consultation / insured patient older than 18 for each emergency situation
maximum 2 consultations for children 0-18 years for each emergency situation
2. Specialized medical consultation for acute and subacute disorders as well as exacerbations of chronic diseases maximum 3 consultations / insured patient / episode that can be granted within a maximum of 60 calendar days from the date of the first consultation
maximum 2 consultations for the insured with a diagnosis already confirmed at hospital discharge
3. Specialized medical consultation for chronic diseases maximum 4 consultations / quarter / insured patient, but no more than 2 consultations per month
maximum 2 consultations for the insured with a diagnosis already confirmed at the hospital discharge
4. Detection of diseases with potential endemo-epidemic 1 consultation per insured person for each disease with suspected and confirmed endemo-epidemic potential
5. Consultations for family planning services 4 consultations per calendar year / insured patient
6. Palliative care services – palliative care consultations maximum 4 consultations / quarter / insured patient, but no more than 2 consultations per month
7. Pregnancy and postpartum services  
   a) monitoring the progress of the pregnancy, quarterly; 1 consultation / quarter
   b) follow up of the mother in the first trimester after birth. 1 consultation
Name of medical service Number of points Minimum guaranteed value of the point per service (lei) Rate settled by the health insurance house for a medicine doctor (lei) Tariff settled by the health insurance house for the primary doctor (lei)
c1 c2 c3 c4=c2*c3 c5=c4+c4*20%
Consultation for medical specialties for the child between 0 and 3 (up to the age of 4) 16,2 2,8 45,36 54,4
Consultation for surgical specialties for the child between 0 and 3 (up to the age of 4 ) 17,25 2,8 48,3 58,0
Consultation of pediatric psychiatry and psychiatry of the child between the ages of 0 and 3 (up to the age of 4) 32,4 2,8 90,72 108,9
Consultation of the child and the adult between the ages of 4 and 59 for medical specialties 10,8 2,8 30,24 36,3
Consultation of the child and the adult between the ages of 4 and 59 years for surgical specialties 11,5 2,8 32,2 38,6
Family planning consultation 10,8 2,8 30,24 36,3
Consultation of neurology for the child between 0 and 3 (until the age of 4) 21,6 2,8 60,48 72,6
Consultation of neurology of the child and the adult between the ages of 4 and 59 14,4 2,8 40,32 48,4
Consultation of psychiatry and pediatric psychiatry of the child and the adult between the ages of 4 and 59 21,6 2,8 60,48 72,6
Psychiatry consultation over 60 years old 23,6 2,8 66,08 79,3
Consultation for medical specialties over 60 years old 12,8 2,8 35,84 43,0
Consultation for surgical specialties over 60 years old 13,5 2,8 37,8 45,4
Consultation of neurology over 60 years old 16,4 2,8 45,92 55,1
Consultation for palliative care 18 2,8 50,4 60,5

Health services related to the medical act

List of health services related to the medical act Number of points Minimum guaranteed value of the point per service (lei) Rate settled by the health insurance house for a medicine doctor (lei)
c1 c2 c3 c4=c2*c3
a) Pediatric neurology and neurology:
a1) the services provided by the psychologist specialized in clinical psychology, psychological counseling and psychotherapy: x
a1.1) clinical and psychological psychiatric evaluation; 30 points / session 2,8 84
a1.2) clinical psychological counseling for children / adults; 30 points / session 2,8 84
a1.3) child / adult psychotherapy; 30 points / session 2,8 84
c) Pediatric psychiatry and psychiatry:
c1) the services provided by the psychologist in the specialty clinical psychology, psychological counseling and psychotherapy: x
c1.1) clinical and psychological psychiatric assessment 30 points / session 2,8 84
c1.2) clinical psychological counseling for children / adults 30 points / session 2,8 84

c1.3) Clinical psychological counseling for children diagnosed with autism spectrum disorders (only at the recommendation of the pediatric psychiatry specialist) – in a psychotherapeutic method applicable to the child diagnosed with autism spectrum disorders. >

30 points / session 2,8 84
c1.4) child and family psychotherapy – for children (only at the recommendation of the doctor with pediatric psychiatry specialty) – in a psychotherapeutic method applicable to the child diagnosed with autism spectrum disorders 30 points / session 2,8 84
g) Diabetes, nutrition and metabolic diseases
Services provided by psychologist specialized in clinical psychology, psychological counseling and psychotherapy: clinical psychological counseling for children and adults with confirmed diagnosis of diabetes 30 points / session 2,8 84

 

Diagnostic and therapeutic services
No. crt.

Name of the diagnostic / therapeutic procedure / treatments / therapies Clinical specialties that can perform that service Minimum guaranteed point value per service in effect (lei) Fees paid by the health insurance company for specialist doctors (lei) Fees settled by the primary health insurance house (lei)
  c1 c2 c3 c4=c2*c3 c5=c4+c4*20%
  A. Simple diagnostic procedures: 10 points score x      
5 EKG standard cardiology, internal medicine, geriatrics and gerontology, pneumology, nephrology 2,8 28 33,6
7 spirometry allergy and clinical immunology, pneumology, internal medicine, geriatrics and gerontology, pediatrics 2,8 28 33,6
8 pulse oximetry internal medicine, geriatrics and gerontology, cardiology, pneumology, pediatrics 2.8

28 33,6
15 Wood lamp examination dermatovenerology 2,8 28 33,6
16 determination of the ankle / arm pressure index, respectively finger / arm pressure surgery, rheumatology, neurology, pediatric neurology, diabetes, nutrition and metabolic diseases, internal medicine, geriatrics and gerontology 2.8

28 33,6
17 muscle strength measurement with dynamometer neurology, pediatric neurology, geriatrics and gerontology 2.8

28 33,6
18 sensitivity tests (filament test, tuning test, caloric sensitivity test and discriminatory sensitivity test) neurology, pediatric neurology, diabetes, nutrition and metabolic diseases, internal medicine, geriatrics and gerontology, ENT 2,8 28 33,6
19 clinical trials (EDS, myasthenic score, UPDRS, MMS, Raisberg) neurology, pediatric neurology, psychiatry, geriatrics and gerontology 2,8 28 33,6
20 harvest bioptic material dermatovenerology, general surgery, pediatric surgery and pediatric orthopedics 2,8 28 33,6
  B. Medium complexity diagnostic procedures: score 20 points x      
7 dermatoscopy dermatovenerology 2,8 56 67,2
  C. Complex diagnostic procedures: score 40 points x      
2 determining the evoked potentials (visual, auditory, somatoesthetic) neurology, pediatric neurology, ophthalmology, ENT 2,8 112 134,4
  D. Simple therapeutic procedures / surgical treatments: 15 points score x      
17 cryotherapy in skin lesions dermatovenerology 2,8 42 50,4
18 surgical treatment of skin lesions – superficially cut wounds, superficial punctures, skin necrosis, scales, wound dehiscence (anesthesia, excision, suture, including removal of wires, dressing) dermatovenerology, surgery, including cosmetic plastic surgery and reconstructive microsurgery, pediatric surgery and pediatric orthopedics, orthopedics and traumatology 2,8 42 50,4
  E. Therapeutic procedures / complex surgical treatments: 25 points score x      
  F. Therapeutic procedures / simple medical treatments: 7 points score      
3 administration of treatment by injection of the soft parts (intramuscular, intradermal and subcutaneous) all specialties 2,8 19,6 23,52
  J. Psychiatric therapies: score 30 points x      
1 non-specific individual and family psychiatric counseling 2,8 84 100,8
  K. Medical genetics therapies: score 30 points x      
1 Genetic advise                                                              2,8 84 100,8

BASIC PACKAGE OF MEDICAL SERVICES IN HOSPITAL MEDICAL ASSISTANCE *)



Each health care unit displays only the conditions (diagnoses) contracted with the health insurance company
List of medical conditions (diagnoses) resolved medical case in day hospitalization
No. crt.

Diagnostic code Disease name (diagnosis) Maximum rate per medical case resolved (lei) Solution fee per medical case negotiated and contracted with the Health Insurance House (lei)
11.   E10.65 Type 1 diabetes mellitus (poor control) 303,12 303,12
12.   E10.71 Type 1 diabetes mellitus with multiple microvascular complications 378,9 378,9
13.   E11.65 Type 2 diabetes mellitus (poor control) 341,86 341,86
14.   E11.71 Type 2 diabetes mellitus with multiple microvascular complications 427,32 427,32
15.   E11.9 uncomplicated type 2 diabetes mellitus (sugar) 305,81 305,81
16.   E13.65 Other specified forms of poorly controlled diabetes mellitus 427,32 427,32
17.   E44.0 Moderate protein-energy malnutrition 362,46 362,46
18.   E44.1 Poor protein-energy malnutrition 362,46 362,46
19.   E66.0 Obesity due to caloric excess 305,19 305,19
20.   E78.2 Mixed hyperlipidemia 381,48 381,48
25.   I20.8 Other forms of angina pectoris (* without coronary artery) 273,62 273,62
26.   I25.11 Atherosclerotic cardiomyopathy of the native coronary artery 322,4 322,4
27.   I25.9 Chronic ischemic heart disease, unspecified, without coronary artery 302,74 302,74
28.   I34.0 Mitral insufficiency (valve) (* without indication of surgery) 379,67 379,67
29.   I35.0 Aortic stenosis (* without indication of surgery) 400,68 400,68
30.   I35.1 Aortic insufficiency (* without coronary artery; no indication of surgery) 381,12 381,12
31.   I67.2 Cerebral atherosclerosis 322,4 322,4
32.   I67.8 Other cerebrovascular diseases, specified 322,4 322,4
33.   I83.9 Varicose veins of the lower extremities without ulceration or inflammation 383,92 383,92
99.   Z50.9 Care involving a rehabilitation procedure, unspecified 331,17 331,17
100.   Z51.88 Other specified health care 331,17 331,17
101.   I25.5 Ischemic cardiomyopathy 273,62 273,62
102.   I70.21 Atherosclerosis of the limbs with intermittent claudication 273,62 273,62
103.   I80.3 Unspecified lower limb phlebitis and thrombophlebitis 383,92 383,92
105.   I83.0 Varicose veins with ulceration of the lower extremities 383,92 383,92
106.   I87.2 (chronic) (peripheral) venous insufficiency 383,92 383,92