Patients’ rights: when can a doctor refuse care and what do you not have to pay for?

Question: A dental office turned me down, saying I wasn’t getting preventive exams. Is this a reason to refuse care?

A: Your registering doctor can indeed exclude you from the register under certain conditions, but he/she must follow the applicable legislation, namely the Health Services Act, in particular its provision § 48.

This states in paragraph 2, among other things, that “A provider may terminate care for a patient if he or she has ceased to provide the cooperation necessary for the continued provision of health services; this does not apply if the failure to provide cooperation is related to the patient’s health condition.”

However, the termination of care must not result in imminent danger to the patient’slife or serious harm to the patient’s health. For example, if the patient has an acute problem that requires immediate care, the physician must admit the patient.

The reasons for refusing to admit a patient to care under paragraph 1 or terminating care under paragraph 2 are assessed by the provider. The provider shall issue a written report to the patient stating the reason for refusal of admission or termination of care.

For example, if a patient has a long history of ignoring preventive care appointments or failing to cooperate in the provision of care, this may be grounds for termination of enrolment.

Q: My doctor has refused to prescribe me a drug that another specialist had previously prescribed for me, saying that he is not allowed to prescribe it. So what is it, who decides what I am prescribed?

Only doctors who are qualified to prescribe medicines can prescribe medicines. Some medicines can only be prescribed by a specialist, while others can be prescribed by a GP. The deciding factors are:

• List of restricted medicines – Some medicines can only be prescribed by a specialist (e.g. neurologist, rheumatologist, psychiatrist).
• Practitioner’s competence – If a GP is not qualified to prescribe a particular treatment, they may not prescribe the medicine.
• Insurance company and reimbursement – Some drugs are covered by insurance only when prescribed by a specialist.

Ask the doctor for an explanation. If only a specialist can prescribe the medicine, you can make another appointment with the specialist. If your GP refuses to prescribe a medicine without a clear reason, you can contact the health insurer’s review doctor or make a complaint.

Q: The doctor told me the diagnosis in Latin but did not explain it. Do I have the right to understandable information?

Of course you do. According to the law, a patient has the right to understandable information about his/her health condition. The doctor is obliged to explain everything to you in a way that you can understand and to answer your questions. If the doctor has only given you the diagnosis in Latin or in a generally incomprehensible way, you have the right to ask questions and ask for an explanation in standard English.

If the doctor refuses or is unhelpful, you can complain to the management of the healthcare facility or contact the Patient Ombudsman.

Question: I want to change my GP but my current doctor refuses to give me my medical records, saying she will only send them to the new doctor on request. Do I have the right to request it myself?

According to the Health Services Act , a patient has the right to look at his/her medical records and to make copies or extracts from them.

If you change GPs, your medical records remain with the original doctor, who will pass them on to the new doctor on request. You cannot take the original records personally as it is the responsibility of the health care provider to keep them.

What can you do in this case?

• Ask for a copy of the medical records – the doctor must provide this to you, if necessary for a fee (the amount of the fee is determined by the provider’s price list).
• Ask the new doctor to request the documentation himself.
• If the doctor refuses to give you a copy, you can contact the regional authority responsible for monitoring patients’ rights.

Question: My dentist has started charging for a filling that was previously free. How can I check what the insurance company is covering?

Fillings covered by the health insurance company are subject to the rules of the List of Medical Procedures and the Reimbursement Decree. The insurance company normally covers amalgam fillings for back teeth, while patients often have to pay extra for white (composite) fillings.

However, there are exceptions when a white filling may be covered by health insurance, for example:

• When it comes to front teeth (incisors, canines).
• If the patient has an allergy to amalgam (confirmation required).
• For children, pregnant women and nursing mothers.

If you need to check what is covered, check your health insurance company’s website for the current reimbursement policy. Ask your doctor directly for the price list or for a covered alternative.

If in doubt, you can contact the health insurance company’s helpline and ask for clarification of the specific situation.

If you suspect that a doctor is charging unjustified fees for a covered procedure, you can contact your health insurer’s review physician, who can review the situation.

Question: I was given an informed consent form to sign at the hospital for a procedure. I needed more time to study everything, but it felt like they were pushing me to sign it without giving me time to read it properly. Can I take it home and change my mind?

According to the Health Services Act, a patient has the right to be given clear information about the proposed procedure, its benefits, risks and alternatives. Informed consent must be given freely and without coercion.

If you are unsure, you can have the consent explained to you or take it home and change your mind – unless the procedure is an emergency. In urgent cases (e.g. life-threatening), the doctor may carry out the procedure without consent if it is not possible to get it in time.

If you feel pressured or want to review the consent, tell the staff clearly. You have the right to enough time to make a decision. If you have a problem, you can contact the Patient Ombudsman or complain to the hospital management.

Query: I was in a room with three other patients during my hospital stay and one of them was on the phone loudly all night. Do I have the right to bed rest? Can I ask for another room?

Yes, the Health Services Act says that patients have the right to be treated with consideration and to conditions that respect their privacy and dignity. If you are disturbed by a noisy fellow patient, you have the right to complain and ask for the situation to be resolved.

For example, you can alert staff – a nurse or doctor can ask the patient to be more considerate.
You can also try asking to be moved to a different room, or ask for a superior room – often there is an extra charge, but sometimes the hospital can offer this free of charge in serious cases.

Query: My GP is full and doesn’t book appointments for routine check-ups until two months later. What should I do if my health deteriorates in the meantime? Do I have to wait, or do they have to take me sooner?

According to Section 48(1) of Act No. 372/2011 Coll. on Health Services,a doctor mustprovide health care without undue delay if this is necessary due to the patient’s health condition.

If you are concerned about your health, call the surgery and explain that your condition has deteriorated – the doctor must admit you in an emergency. If you are refused, you can go to a doctor’s emergency service or specialist clinic (if your problem falls within their remit). If you feel your doctor is wrongly refusing you acute care, you can complain to the regional authority that oversees health services.

Question: I went to the emergency room and was only advised to see my doctor and charged a fee of 90 CZK. Isn’t the emergency room there to help me?

A: The A&E is for acute health problems that do not require direct intervention by the emergency services, but at the same time cannot be delayed until your GP’s surgery hours.

If the doctor in A&E has judged that your condition does not require acute intervention and has advised you to see your GP, they have acted in accordance with the emergency service rules.

A fee of CZK 90 is payable under Section 16a of Act No. 48/1997 Coll., on Public Health Insurance, for the use of the emergency room if the patient has not been hospitalized. Exceptions are, for example, children under 18, pregnant women or persons in material need.

If your condition worsens, seek medical help again. If you have any doubts about the doctor’s correct action, you can contact the health insurance company’s review doctor or file a complaint with the hospital management.

Question: My doctor refused to write a request for a specialist examination and said it was not necessary, although I think otherwise. Is there anything I can do to defend myself?

A: The doctor is not obliged to write a referral just on the basis of your request – he or she must assess whether the specialist examination is medically justified.

If the doctor refuses the referral, he or she should explain why he or she does not consider the examination necessary, ideally asking for written confirmation of the refusal and the reasons for it.In some cases, you can contact the specialist directly – some specialist doctors may examine the patient without a referral, but in this case the examination may not be covered by the insurance company. If you have doubts about the correctness of a GP’s procedure, you can complain to the regional authority or the Czech Medical Chamber.

Question: After moving to another region, I was looking for a new gynaecologist. I found a clinic where they were willing to see me, but they asked me to pay a fee of 500 CZK to register. They said it was for the administrative tasks associated with registration. Do I have to pay this fee or is it an unjustified demand?

This question does not have a clear answer. In general, a doctor is not entitled to demand a registration fee or an annual fee. The provision of health services to registered patients is covered by the public health insurance system. Doctors should not make registration conditional on the patient’s payment, in which case they can contact, for example, the insurance company.

On the other hand, a doctor may demand payment for services that are not covered by public health insurance, for example:

• administrative tasks (e.g. certificates for employers, driving licence, initial examination for employment),
• extra care (e.g. certain vaccines or selection of specific supplies),
• non-treatment related tasks requested by the patient.

In practice, fees are often reported not as registration fees, but just for extra services provided, such as weekend consultations, SMS reminders, online consultations. Also, contractual memberships within some clinics include extra service packages. As long as the fee includes only these extra services, it is legal. If the patient feels that the physician is circumventing the prohibition on charging registration fees by charging for extra services, the patient should request a receipt from the physician including the amount and purpose of the payment. Even in this case, he or she may then contact the health insurance company, as this may be a breach of contract with the health insurance company.