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Özel hastaneler, Sağlık Bakanlığı'nın açıklamaları ve yürürlükteki mevzuata karşın arkadan dolanmaya devam ediyor. Sosyal Güvenlik Kurumu (SGK) ve Özel Sağlık Sigortası şirketleri ile yapılan anlaşmalara rağmen vatandaşlardan haksız yere para almanın yolları bulunuyor. Özel hastaneler bu sefer de Özel Sağlık Sigortası 'nın karşıladığı hizmetler için hastalardan para istiyor.
BAHANE ÜRETİYORLAR Sigorta firmasına provizyon bile sunmadan serum, enjeksiyon ve tahlil ücretini hastadan talep eden özel hastaneler, vatandaşı çileden çıkarıyor. Hastalar, "Özel sağlık sigortam var, aldığım hizmetleri karşılıyor" dese de hastane, "Sigortanın bize verdiği ücret yetmiyor, acil doktorumuz parasını alamıyor" gibi bahanelerle ücret alıyor. Oysa ki özel hastanelerin sigortaya provizyon sunması, ret cevabı gelirse hastadan ücret talep etmesi gerekiyor.
ÖZEL HASTANELER YORUMDA BULUNAMAZ Konuyla ilgili Türkiye Sigortalar Birliği 'nden verilen yanıt ise özel hastanelerin oyununu ortaya çıkardı. "Özel hastaneler yorum yapamaz" açıklamasında bulunan Türkiye Sigortalar Birliği'nden bir yetkili şu ifadeleri kullandı:
"Özel hastaneler sigorta şirketinin provizyon vermesine ilişkin yorumda bulunamaz, çünkü her poliçenin şartı farklıdır. Hastane, sigorta şirketinden provizyon ister, sigorta poliçesinin kapsamında olmayan bir durum varsa ve ret cevabı gelirse sigortalıdan ödeme talebinde bulunabilir.
Böyle durumlarla karşılaşılması durumunda sigorta şirketlerimize her daim ulaşılabilir ve şirketler sigortalılarının haklarını korur. Öte yandan özellikle altını çizmek isteriz ki, özel sağlık sigortası ile devletimizin üstündeki sağlık yükü önemli ölçüde azalmaktadır. Bu nedenle özel sağlık sigortasının daha da fazla tabana yayılması adına yoğun şekilde çalışıyoruz."
BU BİR SUÇ! Sabah'ta yer alan habere göre, Özel Hastaneler ve Sağlık Kuruluşları Derneği (OHSAD) Yönetim Kurulu Başkanı Doktor Reşat Bahat, "Hastanın, Özel Sağlık Sigortası kapsamındaki haklarının kullandırılmaması bir suçtur" dedi. Bahat, hasta ile sigorta arasındaki sözleşmede tanımlı olan her türlü işlemi hastanelerin sigortaya fatura etmek zorunda olduğunu vurgulayarak şöyle devam etti:
"Yaşadığınız bu durum, şikâyet edilen hastane ile sigortanın sözleşmesinin iptaline sebep olur.
Derneğimize de bu tarz şikâyetler geldiğinde biz hastanelere 'Vatandaşın parasını ödeyin' diyoruz. Hastalar hiçbir şekilde mağdur edilemez. Hastane ile sigorta arasındaki anlaşmazlıkların bedeli hastalara ödetilemez. Herhangi bir hata yapıldıysa, vatandaşın mağduriyetinin hastane tarafından giderilmesi gerekiyor."
ÜCRET İADESİ ALINABİLİR Özel Sağlık Sigortası 'nın kapsadığı hizmetlerden ücret talep edilmesinin hukuka aykırı olduğunun altını çizen Av. Ece Değer Kalyoncu, "Hizmetler sigorta kapsamına giriyorsa, hastanelerin hizmet bedelini sigorta şirketlerinden tahsil etmesi gerekiyor" dedi.
Kalyoncu, şu ifadeleri kullandı: "Aldığı hizmetin sigorta kapsamında olduğuna bilen vatandaşlar ödeme yaptıysa, ücret iadesini alabilmek için öncelikle ilgili hastaneye başvuru yapmalı. Reddedilmesi durumunda, ücret iadesi talebiyle Tüketici Hakem Heyeti'ne başvurabilirler.
Dilekçe ekinde ise, talebin reddedildiğine dair belge, fatura ve tedaviye ilişkin belgeler sunulmalı. Vatandaşlar ayrıca haksız ücret tahsil eden hastanelerden Sağlık Bakanlığı ve Cimer kanallarıyla şikâyetçi olabilirler."