STORY: Read about how the right to treatment works in practice
Grounds for Leena’s right to treatment
Leena may apply for prior authorisation from Kela for treatment that is provided in another EU or EEA country or in Switzerland. Prior authorisation is a payment commitment on the basis of which Leena’s municipality of residence is responsible for the costs of treatment provided abroad.
For the prior authorisation decision, Kela always requires a statement from the public health care unit responsible for the patient’s treatment. Kela must grant prior authorisation if the statement recommends it. In order to receive prior authorisation, Leena’s need for treatment must be medically justified and she must be entitled to the treatment in question in Finnish public health care, but the public health care provider cannot arrange for treatment within a medically justifiable time period. Public health care may also consider granting the authorisation in other situations, such as for language reasons.
In Leena’s case, she received a statement recommending prior authorisation from her own hospital district and enclosed it with her application. Since Kela has provided Leena with prior authorisation for treatment, she may also receive retroactive reimbursement from Kela for costs of travel, medication, accommodation and an accompanying person. For treatment received with prior authorisation, Kela will reimburse travel costs to the treatment facility.