How to use BPJS for outpatient treatment?

Every BPJS Kesehatan card holder will get free health services which include outpatient and inpatient care. However, even if you have the card, you may not know how to claim medical treatment using BPJS for outpatient care when one day it is needed. Quiet. We will explain all the details in this article.

What health facilities are covered by BPJS?

Quoting the official BPJS website, every owner of a BPJS card aka Healthy Indonesia Card (KIS) will have access to the following health services:

1. Service administration.
2. Promotional and preventive services.
3. Medical examination, treatment and consultation; including outpatient care.
4. Non-specialist medical action, both operative and non-operative.
5. Medical services and consumable medical materials.
6. Blood transfusion according to medical needs.
7. First-level laboratory diagnostic investigations.
8. First degree hospitalization as indicated.

When all the administrative requirements are complete, you can seek treatment without having to spend money because all costs are borne by the BPJS, including medicines. However, there are certain types of drugs that are not covered by BPJS, so you have to buy them yourself.

How to claim treatment using BPJS for outpatient treatment

As a card owner, you should know the proper procedure for medical treatment using BPJS so that in the future you don't get confused when you want to claim it.

Well, you need to follow these steps if you want to use BPJS for outpatient care:

1. Visiting FASKES 1

BPJS Kesehatan applies a tiered referral system. So you can't come to the hospital just with your BPJS card for outpatient care.

First of all, you must go to FASKES 1 (Health Facility 1), which includes your family doctor or local health center and clinic, according to what you filled in on the BPJS registration form. You can see the FASKES 1 information where you are registered on your BPJS card.

FASKES 1 is the starting point for you to get basic medical examinations. If you have been examined at FASKES 1 and it is still manageable and treatable, you do not need to go to the hospital.

If not, FASKES 1 can provide you with a referral letter for treatment at the nearest advanced level health facility (FKRTL) that has collaborated with BPJS Kesehatan. Referral hospitals are usually equipped with facilities and infrastructure that are better able to support your medical complaints.

2. Care at a referral hospital

After you are referred to a BPJS partner hospital, all medical examinations and actions will be transferred to this hospital. With notes:Bring your BPJS card, personal identity card, and FASKES 1 reference letter when going for treatment.

You can continue to use BPJS for outpatient treatment until the doctor treating you states that your condition is stable. You will also be given a certificate stating that you are still undergoing treatment at a referral hospital.

Remember: Referral letters must not be lost. Without this letter, you will be considered to be treated using your personal money without using a BPJS claim. So you must show it every time while you are still outpatient using BPJS.

If the doctor states that your condition has improved, you will be referred back to the initial FASKES by providing a return reference letter.

3. Pay attention to the validity of the referral letter for outpatient treatment

The referral letter provided by the FKTP has a validity period. This means that you cannot use the referral at will, whenever you want. Reference letters can generally continue to be used for up to three months from the initial publication of the letter.

As long as it has not expired, you are still required to seek treatment at a referral hospital. If your condition has not improved after 3 months, you can extend the validity of the same referral letter by repeating the procedure from the beginning. Return to the FASKES where you were registered for basic medical examinations and renewal of referrals.

You can use BPJS for treatment without referral only for emergency cases

To be able to get free treatment with BPJS, you must follow the steps above. The BPJS will not cover your medical expenses if you only bring yourself to the hospital without an official referral letter.

However, for emergency cases that can be fatal if not treated immediately, you can go directly to BPJS Kesehatan partner hospitals without having to have a referral letter.

Can you complain about services while using BPJS Kesehatan?

Each BPJS card holder has the right to report complaints or dissatisfaction related to the health services undertaken by contacting the 24-hour BPJS Health call center (1500 400). If you want more details, you can come directly to the nearest BPJS Kesehatan office.