General nursing at GESS - Who are the beneficiaries and what does GESS cover?
All the answers regarding the general nursing services that joined the GESS in December 2020
Home nursing services joined the GESS in December 2020, offering the opportunity to specific groups of beneficiaries to receive specialized health care services at home.
The access to the specific services is made upon referral by the Personal or Special Doctor and concerns beneficiaries who have been registered by the Personal Doctor as "recumbent". In other words, in cases where the beneficiary, due to serious health problems, can not move from the place where he is, there is the possibility that his health care services are provided at home.
Therefore, when the beneficiary obtains the relevant referral from the Personal or Specialist Doctor, he has the right to choose from the list of providers participating in GESS, the one who wishes to offer him the services he needs at home. The beneficiary must then arrange an appointment with the nurse of their choice.
GESS covers a specific maximum number of sessions for home general nursing services per beneficiary, per year.
All patients (children and adults) are entitled to receive up to 12 visits per year, which are covered by the System. In exceptional cases where the treating physician and the nurse decide that the patient needs more visits, then they have the opportunity to request a larger number of visits. This request will be evaluated by the Agency, provided that all the necessary information and relevant documentation are provided.
Each new year, the beneficiary has the opportunity to receive up to 12 visits, if of course the conditions are met for which the GESS reimburses the services of home nursing.
The medical devices or consumables that each beneficiary needs for his health care at home, are prescribed by the respective doctor. They can be downloaded depending on the type or from hospital pharmacies (or hospital warehouses) either from private pharmacies. Products supplied by private pharmacies are labeled "IF".
In cases where the beneficiary or other relative is not able to receive the necessary consumables himself and in case there is a relevant authorization, the System enables the nurse to obtain them on behalf of the beneficiary. In this case the nurse should ensure the appropriate authorization from the beneficiary. The nurse should provide the pharmacy with personal details of the beneficiary such as ID number and date of birth.
FREQUENTLY ASKED QUESTIONS
Can a beneficiary receive services outside GESS from a nurse who is contracted with the System?
In cases where the beneficiary does not own or does not submit a referral with services reimbursed by the GESS, then the nurse has the opportunity to provide his services, which however will not be reimbursed by the System. Nevertheless, it must inform the beneficiary from the beginning that it will receive services outside the System. The same applies in cases where the beneficiary has exhausted the maximum number of visits he is entitled to, as defined by the Agency.
Can the beneficiaries receive services during the weekend?
The Health Insurance Organization does not specify the working days / hours of each provider. In such cases, however, the provider must comply with the regulations issued by the Agency in relation to the total duration of services in order to ensure the provision of quality health care services to the beneficiaries.
Can a beneficiary who is hospitalized in a hospital not contracted with the OAY, receive services from a nurse contracted with the GESS?
If it is a patient who is hospitalized in a hospital not contracted with the OAY and who does not have a referral for the provision of Nursing Health Care services, then the Nurse can continue to offer his services outside the GESS, at the expense of the beneficiary.
In case of provision of services during the hospitalization of a beneficiary in a hospital contracted with GESS, these services are reimbursed according to the DRG coding system in which they are included.