My husband has been diagnosed with avascular osteonecrosis. According to the doctors, his hip joint should be replaced with an artificial one. Please clarify, does the He alth Insurance Fund cover the change itself?
Stanka Hristova, Pazardzhik
Yes, your husband can be admitted to a medical facility for inpatient care that has signed a contract with the NHSOC under clinical pathway (CP) 218 "Operative procedures with hip and knee alloplasty".
NHOK pays hospital care providers for all medical activities, including: examinations, preoperative preparation, anesthetics, surgery, treatment in the hospital with the appointment of two control examinations within 30 days after discharge, necessarily recorded in the epicrisis, in the same medical facility for inpatient care.
NHOC pays the medical facility the cost of the hip prosthesis separately from all activities on the clinical pathway. The amount paid by the NHIF for a hip prosthesis varies (BGN 1,500, BGN 1,080, BGN 1,560…), depending on the type of joint. The most suitable medical device is determined by the attending physician.
The additional payment by the patient depends on the product that is needed specifically for his case. If the patient pays extra for a medical device, he gives an amount that represents the difference between the value of the device (purchased by the hospital) and that paid by the NHIF. The hospital must issue documents (including an invoice) that specify exactly what the patient is paying for.
The patient pays a user fee of BGN 5.80 for the hospital stay - an amount determined by a decree of the Council of Ministers - for each day of hospital treatment, but for no more than 10 days per year (unless he is exempted from it).