Don't Get It Wrong: These 5 Operations Are Not Covered by BPJS Kesehatan
BPJS Kesehatan provides health service guarantees for the public who are registered as participants. With active participant status, participants can obtain health services at facilities that cooperate with BPJS Kesehatan in accordance with applicable regulations.
Like a health insurance system, BPJS Kesehatan participants are required to pay contributions every month. Various medical services can be covered, including surgical procedures, as long as they meet the requirements and procedures that have been established.
However, not all surgical procedures are included in the scope of services covered by BPJS Kesehatan. There are a number of conditions and types of operations that are excluded from coverage. What are they?
List of operations not covered by BPJS Kesehatan:
Operations due to the impact of an accident
Cosmetic or aesthetic surgery (operations that are not harmful to health)
Operations due to self-inflicted injury (operations resulting from carelessness or negligence that caused injury)
Operations at foreign hospitals (operations performed outside the reach of BPJS Kesehatan)
Operations that do not comply with BPJS Kesehatan procedures (operations that do not complete the appropriate submission procedure)
Nevertheless, based on the guidelines for the implementation of the National Health Insurance (JKN), namely Minister of Health Regulation (Permenkes) Number 28 of 2014, there are 19 types of operations covered by BPJS Kesehatan, namely:
Heart surgery
Caesarean section
Cyst surgery
Myoma surgery
Tumour 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 surgery
Thymectomy
In order to obtain BPJS coverage for surgical procedures, patients must seek treatment at a first-level health facility, such as a community health centre or clinic that has been approved by BPJS Kesehatan.
If a surgical procedure is required, the patient will be given a referral letter to a hospital and will receive a surgery schedule from the relevant doctor at the hospital.
In addition, there are three requirements that must be met and obtained by the patient to obtain surgery coverage from BPJS Kesehatan, namely a BPJS Kesehatan card or Healthy Indonesia Card (KIS), a referral letter from the community health centre/first-level health facility, and a patient card from the hospital.