The FEDERATION seeks via this information note to ensure the long term viability of our sickness insurance scheme (JSIS) and to enable you to take informed decisions.
Theme of the day: hospital billing
We are very attached to our sickness insurance scheme, the JSIS, and wish to see it work well and in a sustainable manner for the benefit of all colleagues.
The key points that motivate us are:
- Maintaining all colleagues' freedom to use the health professionals and health establishments of their choice;
- Seeking improvements to reimbursement rates;
- Demanding ever more transparency in the individual decisions taken by the PMO;
- Strict management of the JSIS's financial resources.
Those are the same principles that the FEDERATION regularly defends within the JSIS Management Committee ("CGAM").
Regarding the supplements billed by some hospitals, the Federation wishes to bring certain facts to your notice.
The PMO has negotiated conventions with certain hospitals in the Brussels region, with the aim of limiting the supplements that can be charged to patients who opt for a private room.
Sometimes very significant supplements are applied to specialists' fees (surgeon, anaesthetist, gynaecologist, orthopaedic surgeon, etc.).
Here is the list of medical establishments who have agreed to reduce such supplements from 300% to 200% (or even 175% in the case of UZ Brussel) for JSIS members:
- Cliniques Universitaires St. Luc
- Hôpital ERASME
- UZ Brussel
- Cliniques de l'Europe (St. Michel et St. Elisabeth)
- Hôpital universitaire des enfants Reine Fabiola (IRIS)
- Institut Jules Bordet
- Les hôpitaux IRIS-Sud (Etterbeek, Baron Lambert, Molière-Longchamp)
Please note that some hospitals, particularly those of the CHIREC group (Edith Cavell, Parc Léopold, …), have refused to sign a convention with the PMO.
Colleagues who chose to use hospitals that practice higher supplements, such as the CHIREC group, should be aware of what they are letting themselves in for.
For information, we are republishing the analysis carried out by a mutual insurance organisation (la Mutualité Chrétienne), which has for the 12th consecutive year published the average hospital bills for its members for a given year (the figures below are for 2015).
The results, based on an analysis of 1.4 million members' bills from 101 hospitals, are the following:
Top 10 hospitals with the highest supplements (%) for private rooms (Mutualités Chrétiennes)
1 Percentage stated in the admission statement.
Another important precision: Colleagues should be aware that doctors should not force them to take a private room. An opinion of the national medical council for Belgian doctors has been published on this issue (opinion of 22 February 2014 and press brief issued the 7 February 2015): https://ordomedic.be/fr/avis/conseil/pratique-de-certains-mdecins-consis....
If ever you are in that positon, we advise you not to accept if you do not wish to have a private room imposed on you.
In addition, Belgian law provides for an exemption to supplements for private rooms in the following cases:
- if the patient is under 18
- if the patient is in intensive care
- if isolation is a medical necessity
- if all shared rooms are occupied.
On the basis of this information, the Federation invites you to take informed decisions to reduce the risk of unfortunate surprises: additional costs for you and for the JSIS.
Don't hesitate to tell us of your experience and if you encounter any problems. The better informed we are, the better able we will be to defend your interests within the JSIS Management Committee!
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