Announcement Regarding Court Disputes with a Foreign Hospital

This concerns insured persons who, by a decision of the Fund, were referred for treatment at the foreign hospital in 2016, 2017 and 2018, for which an advance payment was made in accordance with a submitted pro forma invoice from the hospital itself. The decision states in which health institution the insured person will be treated, what period of hospital treatment is approved, and how much money is approved according to the previously issued pro forma invoice from the foreign hospital.

Together with the decision, the Fund also prepared a letter - notification to the foreign hospital informing it that the submitted pro forma invoice had been accepted and that, if during the treatment there was a need to extend the hospital stay beyond that approved by the Fund and/or a need for additional costs, the Fund should be notified immediately.

Also, with this notification, the Fund informs that costs which have not been approved in advance will not be accepted and paid, and that the invoice for the completed hospital treatment should be submitted within 30 days of its completion, for the purpose of financially closing each case individually.

The court disputes arise because the foreign hospital did not act in accordance with the instructions given in the Fund’s notifications and informed the Fund of the claims for additional costs more than two years later, namely at the beginning of 2020, which is not in accordance with the legal regulations prescribed by the Fund.

Such untimely action by the hospital led to the Fund and the insured persons having no knowledge of the final costs of the treatment, so that they could initiate a procedure with a request for recognition of the difference between the approved advance and the final costs, or the so-called additional treatment costs.

The Fund took all necessary actions within its competence in a timely manner and referred the insured persons for treatment at the foreign hospital. Meanwhile, in the area of financial and accounting closure of payments with the hospital, court proceedings are ongoing.