BPJS Kesehatan is a type of government-owned health insurance. Automatic, there will be many people who use this facility. Included in taking care of hospitalization claims at the hospital. Do you know the procedure for filing BPJS for hospitalization? What must be prepared first? Try referring to the following review.
Basic procedure using Health BPJS
BPJS Kesehatan, which is a government-owned insurance that has a variety of services, ranging from covering outpatient treatment, hospitalization, to referring to surgery. The main requirement for being able to use a health BPJS is to be registered as a participant first.
Before you or your family members get sick to need hospitalization, you should indeed have registered first in the Health BPJS system.
Then, monthly premiums or installments BPJS Your health must be paid regularly. If you are in arrears when you or your family is sick, then the process of using BPJS Kesehatan will certainly be hampered.
You will be asked to complete arrears first. Whether before outpatient health facilities (hereinafter referred to as health facilities) level 1 or hospitalization, all payments must be completed first.
Requirements for hospitalization with Health BPJS
For patients who are not emergency, for hospitalization you must go to level 1 health facility first. Level 1 health facilities, for example puskesmas or special clinics that have collaborated with BPJS Kesehatan.
Then, quoted from the Health Service Practical Guide, if the level 1 health facility has inpatient facilities, the patient can be hospitalized at the health facility. If not, the doctor in health facility 1 will refer you to the hospital (facility level 2) for hospitalization. For that there are several files that you need to prepare:
- Photocopy of family card
- Photocopy of KTP
- Original health BPJS card and photocopy
- A reference letter made by a medical doctor at level 1
- Participant Eligibility Letter (SEP)
- Treatment card
How to use BPJS Kesehatan for hospitalization in level 2 health facilities
After submitting the file at the hospital referred by the level 1 health facility, you will be re-examined by the doctor at the hospital. The doctor will tell you when the patient can start hospitalization or does not need to be hospitalized, but is given treatment for outpatient treatment at home.
If you will be treated at a level 2 health facility, follow the next procedure as an inpatient. Usually after the action is given, or the medication needed as recommended by the doctor, you will be asked to sign a proof of service sheet.
This is where the hospital or health facility will take notes. Recording will be included next to a special system provided by BPJS Kesehatan.
Furthermore, the Health BPJS will pay for your medical expenses according to the records provided by the hospital. In this case, the BPJS is cashless, ie you do not need to spend money to pay for hospital fees first. All costs are issued directly by BPJS Health to the hospital.
However, not all actions or drugs will be borne by the BPJS. If there are several actions or drugs from a doctor who do not enter the BPJS Health service, then the patient pays for the action or the drug itself.
Therefore, discuss as much as possible with doctors and hospital staff about procedures, actions, and all administrative matters related to your treatment.
What if level 2 health facilities can't handle?
If you are unable to handle your case or illness in level 2 before (for example due to lack of facilities or specialists), you will be referred to a larger hospital. The procedure is more or less the same when you enter hospital level 2 health facilities. In addition to preparing the prerequisite documents, attach also the reference letter file from the second facility to level 3 health facilities.
Next, 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.
The next flow is more or less the same as in level 2 facilities, just different places.
In essence, the claim of hospitalization from BPJS Kesehatan will directly be carried out by the hospital to BPJS Kesehatan. BPJS users must prepare complete administrative data, then the hospital will confirm to the BPJS.
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