5 Surgeries Not Covered by BPJS Kesehatan: Check Before Seeking Treatment
BPJS Kesehatan participants can access healthcare services at clinics, community health centres (puskesmas), and hospitals that collaborate with the institution. For many participants, monthly premiums must be paid to maintain eligibility.
However, it is important to note that not all services are covered by BPJS Kesehatan. This includes certain surgical procedures that are excluded from the coverage.
Here are five types of surgeries not covered by BPJS Kesehatan:
Cosmetic or Aesthetic Surgery (surgeries that do not pose a threat to health).
Surgery Resulting from Self-Harm (surgeries resulting from acts of carelessness or negligence that lead to injury).
Surgery Performed in Overseas Hospitals (surgeries conducted outside the scope of BPability of BPJS Kesehatan).
Surgery Not Following BPJS Kesehatan Procedures (surgeries that do not complete the appropriate application procedures).
List of Surgeries Covered by BPJS Kesehatan
Minister of Health Regulation Number 28 of 2014 regulates the types of surgeries covered by BPJS Kesehatan. To access these, patients must first seek treatment at a primary healthcare facility (faskes).
From the primary facility, a referral to a hospital will be provided if surgery is required. Subsequently, the relevant doctor will provide the surgery schedule.
The following is a list of 19 covered surgeries:
Heart Surgery
Caesarean Section
Cyst Surgery
Myoma Surgery
Tumor Surgery
Odontectomy
Oral Surgery
Appendectomy
Gallstone Surgery
Eye Surgery
Vascular Surgery
Tonsillectomy
Cataract Surgery
Hernia Surgery
Cancer Surgery
Lymph Node Surgery
Pin Removal Surgery
Knee Joint Replacement
Thymectomy
It should also be noted that there are three requirements necessary to obtain surgical coverage from BPJS Kesehatan, namely:
BPJS Kesehatan Card or the Indonesia Health Card (KIS).
A Referral Letter from a Puskesmas or primary healthcare facility.
A Hospital Patient Card.