The general practitioner or specialist doctor from a hospital for outpatient care may issue a consultation and co-treatment referral. The referral is issued at the discretion of the physician (not at the patient's request) when there is a need for additional tests and consultation with a physician with a particular specialty.

The referral may be used within 30 days of its issue. The referral determines the physician's specialty, but not the doctor to do the consultation.

 It is the right of the patient to choose which doctor with that specialty to perform the consultative ecamination. The patient does not pay for the consultation except for the patient's fee. The consultation and treatment referral is both a medical and financial document.

It is a medical document through which interaction between physicians with different specialties takes place and is part of the healing and diagnostic process. It is a financial document on the basis of which the consideration of the specialist doctor is paid. This dual nature of the consultation and treatment referral creates a risk of over-spending of funds for the NHIF when issuing Fictive referrals. In order to limit the risk of abuse, the NHIF has introduced the so-called Regulatory standards that limit a certain number of referrals that a physician can issue. As a result, it often happens that the doctor refuses to issue a referral, under the threat of a sanction imposed by the NHIF. Many such cases have litigation. The practice of the Supreme Administrative Court is contradictory. The recent decisions support the thesis that while you are health-insured, you have to pay for your treatment if the limit of the referrals is exhausted.

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