Table of contents:
- Basic procedure using BPJS Kesehatan
- Requirements for hospitalization with BPJS Health
- How to use BPJS Health for hospitalization at level 2 health facilities
- What if the level 2 health facility cannot handle it?
BPJS Kesehatan is a type of government-owned health insurance. Automatically, there will be many people who use this facility. Included in handling claims for hospitalization. Do you know what is the procedure for applying for BPJS for hospitalization? What must be prepared in advance? Try to see the following reviews.
Basic procedure using BPJS Kesehatan
BPJS Kesehatan, which is government-owned insurance, has various services, ranging from covering outpatient treatment, inpatient care, to referral, to surgery. The main requirement to be able to use BPJS Kesehatan is to have been registered as a participant first.
Before you or any of your family members get sick and need hospitalization, it is best if you have registered yourself first in the BPJS Kesehatan system.
Then, your BPJS Health monthly premiums or installments must be paid regularly. If you are in arrears when you or your family are sick, the process of using BPJS Kesehatan will certainly be hampered.
You will be asked to settle arrears first. Either before outpatient treatment at a level 1 health facility (hereinafter referred to as faskes) or hospitalization, all payments must be completed in advance.
Requirements for hospitalization with BPJS Health
For patients who are not in an emergency department, for hospitalization you have to go to a level 1 health facility first. Level 1 health facilities, for example health centers or special clinics that have collaborated with BPJS Kesehatan.
Then, reported from the Practical Guidelines for Health Services, if the level 1 health facility has inpatient facilities, the patient can be hospitalized at the health facility. If not, the doctor at health facility 1 will refer you to the hospital (level 2 health facility) for hospitalization. For that there are several files that you need to prepare:
- Photocopy of family card
- Photocopy of KTP
- Original and photocopied BPJS health card
- Referral letter made by a level 1 health facility doctor
- Participant Eligibility Letter (SEP)
- Medical card
How to use BPJS Health for hospitalization at level 2 health facilities
After submitting the files at the hospital referred to by the level 1 health facility, you will be checked again by the doctor at the hospital. The doctor will tell you when the patient can start being hospitalized or not need to be hospitalized, but will be given treatment for outpatient treatment at home.
If you will be admitted to a level 2 health facility, follow the next procedure as an inpatient. Usually after being given the action, or the required medication as recommended by the doctor, you will be asked to sign a service proof sheet.
This is where the hospital or health facility will keep records. The registration will then be entered into a special system provided by BPJS Kesehatan.
Furthermore, BPJS Kesehatan will pay for your medical expenses according to the records provided by the hospital. In this case, the BPJS is cashless that is, you don't have to spend money to pre-pay hospital bills. All costs are paid directly by BPJS Kesehatan to the hospital.
However, not all actions or drugs will be covered by the BPJS. If there are several actions or drugs from a doctor that are not included in the BPJS Health service, then the patient will pay for the action or drug himself.
Therefore, discuss in as much detail as possible with doctors and hospital staff about procedures, actions, and all administrative matters related to your treatment.
What if the level 2 health facility cannot handle it?
If the level 2 health facility was previously unable to handle your case or disease (for example because of the lack of facilities or specialist doctors), you will be referred to a larger hospital. The procedure is more or less the same when you enter the level 2 health facility. In addition to preparing the prerequisite documents, also attach a referral letter from the 2 health facility to the level 3 health facility.
Furthermore, the level 3 health facility doctor will re-examine the condition of the newly referred patient. If you really need hospitalization, you will be hospitalized at this level 3 health facility hospital.
The next flow is more or less the same as in level 2 health facilities, only different places.
In essence, inpatient claims from BPJS Kesehatan will be made directly by the hospital to BPJS Kesehatan. BPJS users must prepare complete administrative data, then the hospital will confirm with the BPJS.
