Treatment Abroad Scheme ~ E112
I have applied to have Robert treated in the UK on the basis that the SMART assessment which will improve the quality of his life and determine his future needs is not available here within a reasonable time, and the sooner he gets this assessment the better.
We have been refused on the grounds that the ‘treament is available in Ireland’ even though it says below:
“The treatment must not be available within the state or not available within a time normally necessary for obtaining it.”
The application form reads as follows:
The HSE operates a Treatment Abroad Scheme (TAS), for persons entitled to treatment in another EU/EEA member state or Switzerland under EU Regulation 1408/71, as per the procedures set out in EU Regulation 574/72, and in accordance with Department of Health and Children Guidelines.
A copy of these Regulations and Decisions, and all other aspects of European Law are available on the website for inspection at http://europa.eu
Within these governing EU Regulations and the Department of Health and Children’s Guidelines, the TAS provides for the cost of approved treatments in another EU/EEA member state or Switzerland through the issue of form E112 (IE).
The TAS allows for an Irish based Consultant to refer a patient that is normally resident in Ireland for treatment in another EU/EEA member state or Switzerland, where the treatment in question meets certain criteria.
The application to refer a patient abroad must be assessed and a determination given prior to the patient availing of the treatment abroad. Valid applications will be processed within 15 to 20 working days and a decision will be issued via letter. Appointments should not be scheduled prior to a decision being reached on an application. Appointments that are made prior to decision will have no bearing on the review process or its expedition.
Following clinical assessment, the Irish based referring hospital consultant must provide details of the patient’s condition, the specific treatment being applied for and the provider of the treatment abroad. Once the patient has availed of an approved treatment abroad, the care of the patient reverts immediately to the referring Irish Consultant.
The treatment must not be available within the state or not available within a time normally necessary for obtaining it.
The following must be certified by the Irish based referring Consultant:-
• Their recommendation that the patient be treated in another EU/EEA country and the reason for same;
• That the specific treatment that the patient is to receive outside the State is not available within the State.
• That the treatment is medically necessary and will meet the patient’s needs;
• That the treatment is a proven form of medical treatment and is not experimental or test treatment;
• That the treatment is in a recognised hospital or other institution and is under the control of a registered medical practitioner;
• That the hospital outside the State will accept EU/EEA form E112 (IE) for the costs associated with treating the patient.
Self referrals, referrals from a General Practitioner or a medical practitioner from outside the state will deem any application invalid and not applicable for review by the Treatment Abroad Scheme.
Robert fulfils all these criteria – we have acceptance from an undeniably creditable treatment centre in the UK and it’s medically necessary.