Prices for samoplátce

Samoplátce is a czech word meaning somebody who is paying for a service out of pocket.

If you have public health insurance, then you are paying out of pocket in a very limited number of cases, mostly for over-the-standard services, like a single hospital room or non-mandatory vaccination.

But with private health insurance the situation changes drastically. As the provider network is very small you are often facing a decision – wait several weeks longer and travel long distance to see a doctor from your insurer’s network or visit the doctor of your choice as samoplátce and then file a claim with your insurance company. If you are seeking help for the condition that your private health insurance doesn’t cover (like chronic diseases, oncology, pregnancy before the waiting period is over) you have no option but to pay out of pocket. If the claim is valid, but you have already exceeded the insurance limit – you are also on your own.

And here is when the magic happens – the insurance company may have negotiated low prices with the health care provider, but you definitely didn’t. If you are seeking emergency help you are luckier – the upper limit of how much the hospital would ask you to pay is legally regulated and stands at 146% of what a Czech public health insurance company would have paid in 2020. But if you are managing a chronic condition, like diabetes or chronic kidney disease, nothing stops the health care provider from charging you literally any sum they want, generally you are left with a 300% overprice. Some health providers, like Nemocnica na Homolce or Karlovarska krajska nemocnica, are publishing “the foreigners price list” on their websites, but the majority don’t and the real value of “the foreigners’ coefficient” you learn from the issued invoice.

Every medical service has its value in points that is set by the decree of the Czech Ministry of Health. The cost of 1 point is prone to the observer effect.