Medical Services
Specialized Referral
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Overview of Specialized Referrals
A specialized referral is a system that allows patients who are eligible for government-funded medical care to receive treatment at specialized hospitals when, based on a specialist’s opinion and considering the medical staff, facilities, and equipment of the relevant VHS hospital, it is determined that treatment at the VHS hospital is difficult.
Eligible Persons
Among those eligible for full government coverage of medical expenses at VHS hospitals (excluding those eligible for reduced-cost treatment)
- A patient with an infectious disease, or suspected of having an infectious disease, cannot be appropriately treated within the VHS hospital
- Treatment at the VHS hospital is difficult due to a rare, intractable, or severe disease
- Treatment is difficult due to the absence of a medical department or insufficient facilities at the VHS hospital
However, those who registered after July 1, 2012 and were classified as Disability Grade 7, those who registered after June 23, 2016 and were classified as mild potential aftereffects of defoliants (including second-generation), Grades 12-14 among individuals injured in the May 18 Democratization Movement, and Grade 7 among persons injured in the course of performing a special mission are required to pay 10% of the medical expenses when receiving treatment at medical institutions other than their designated hospital for injury treatment
Specialized Referral Treatment Procedure
If the attending physician determines after examination that treatment at the VHS hospital is not possible, referral for specialized treatment is permitted only with the approval of the hospital director.
01. ConsultationTreatment at a VHS Hospital
02. Decide on specialized referralIf treatment is not possible at the VHS hospital, the attending specialist issues a Specialized Referral Medical Treatment Application
03. Referral informationGuidelines for referral treatment (referral team), scope of support, and claim procedures
04. Treatment and billingIndividual medical expense claims, receipts, detailed statements, etc.
05. Review of medical expensesReview of medical expenses claimed (Review Division)
06. Payment of medical expensesAfter the review of the claimed medical expenses is completed, the finalized amount is transferred to the individual’s designated bank account
Request for Payment of Medical Expenses
After making payment in advance to the designated medical institution or pharmacy, please prepare the following documents and submit your application
- Original receipt for medical expenses
- Detailed statement of medical expenses
- Original receipt for prescription drugs (attach the prescription)
- Diagnostic results for special examinations (CT, PET-CT, MRI, and Ultrasound) for outpatient visits
- Verification of use for higher-level hospital room
- Bank account in the applicant’s real name (for receiving pension)
The following items of medical expenses incurred during specialized referral treatment are not covered. (Detailed information will be provided separately at the time of referral application)
- Medical expenses (or examination fees) for conditions not referred to by the VHS hospital, or expenses for treatment exceeding the approved period
- Medical expenses incurred due to the patient or guardian voluntarily changing the medical institution
- Arbitrary non-covered medical expenses not specified under the Standards for National Health Insurance Benefits
- Room rate difference for using a higher-level hospital room (only recognized for up to 7 days from the start of hospitalization when the standard room is unavailable; excludes special/private rooms)
- All costs related to the donor incurred during a long-term organ transplant surgery
- Items classified as non-covered under Article 9, Paragraph 1 of the Regulation on National Health Insurance Care Benefits
- Costs for dental prosthetic materials, assistive devices, issuance fees for medical certificates, nursing care fees, telephone charges, medical supplies purchased from specialized medical supply companies or shops, and costs of materials purchased outside domestic medical institutions or pharmacies
- Other cases as separately determined by the Minister of Patriots and Veterans Affairs
