Guided by the immediate and comprehensive care of the beneficiaries regarding situations that require clinical psychology services, in December 2020 the Health Insurance Organization included these services in the package of services of GESS.
Among other things, the services of Clinical Psychologists refer to serious cases of patients whose condition significantly affects their functionality for a long time, or there is a sharp decline in their functionality, due to certain conditions.
Each beneficiary can have access to a clinical psychologist of his choice if he is referred by a Personal Physician or Specialist who participates in GESS, but not directly. The General Health System covers a specific maximum number of sessions per diagnosis and per beneficiary per year, while there is the possibility for each beneficiary to change the health professional to whom he / she was originally addressed.
More specifically:
Adult patients can receive up to 18 treatments, while children and adolescents 24 treatments per year. These numbers refer to a combination of all the diagnoses covered by these services.
In the case of patients whose clinical psychologist and physician consider that they need more treatments, then they should submit a joint request for a larger number of treatments which, if sufficiently documented, will be evaluated by the Organization.
Visits and Referrals
The number of treatments reimbursed by the GESS, depending on the beneficiary's diagnosis, is listed in the tables of covered diagnoses. At the moment, the computer system does not limit the number of referrals that can be issued, but only clarifies whether the referral has been used. However, if a doctor issues a referral to a patient who has exceeded the maximum number of visits, the referral will not be valid and will not be reimbursed.
There are currently two types of referrals, short-term and medium-term. A short-term referral is issued for 3 treatments and has a time limit of 6 months to execute. A medium-term referral is issued for 6 treatments and has a time limit of 6 months to execute. Each referral is valid for a single diagnosis.
The total number of visits of each beneficiary to a Clinical Psychologist is now available through the computer system and concerns the visits made either to the same or to a different provider. The number of visits of each patient is renewed at each change of time. The treatments that a beneficiary is entitled to receive within the framework of GESS are calculated from the beginning of each calendar year.
In cases where the beneficiary does not hold or does not submit a referral in force then it is considered that he receives services outside the GESS. The provider has the ability to serve the beneficiary, informing him from the beginning of his financial obligations. The same applies in cases where the beneficiary has exhausted the maximum number of visits he is entitled to, as defined by the Agency.
At the discretion of the provider is the home service of the patient, as it is not included in the agreed service package. In cases where the beneficiary's condition is such that it needs home care, the provider should note this information in the clinical notes. In any case, one of the existing activities should be used. It is important to note that any home visits may involve additional compensation outside the GESS.
With regard to the provision of services on weekends, the Health Insurance Organization does not specify the working days / hours of each provider. However, the requirements are important to have a reasonable total duration within the same day, in order to ensure the provision of quality health care services to the beneficiaries.
Another parameter that arises is the cases of providing clinical psychology services through GESS, in hospitals not contracted with the OAY for in-hospital cases. In the case of a patient who is hospitalized in a hospital not contracted with the OAY that does not have a referral for the services of a clinical psychologist, then the provider can continue to offer its services outside the GESS. 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.