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Perhatian! Layanan BPJS Kesehatan Kini Tak Lagi 100% Gratis

Kementerian Kesehatan (Kemenkes) akhirnya menerbitkan aturan baru guna mengendalikan biaya kesehatan agar BPJS Kesehatan tidak tekor lagi.

Bila sebelumnya semua biaya perawatan peserta BPJS Kesehatan ditanggung oleh badan ini, dalam aturan baru tersebut sejumlah layanan kesehatan yang dapat menimbulkan penyalahgunaan pelayanan dalam program Jaminan Kesehatan dikenakan urun biaya. Itu artinya BPJS Kesehatan akan membayar biaya sesuai dengan yang ditetapkan, selebihnya ditanggung peserta.

Aturan baru ini termuat dalam Peraturan Menteri Kesehatan (Permenkes) Nomor 51 tahun 2018 tentang Pengenaan Urun Biaya dan Selisih Bayar dalam Program Jaminan Kesehatan. Aturan ini sudah mulai berlaku sejak Desember 2018.

Dalam aturan baru ini, layanan kesehatan yang dapat menimbulkan penyalahgunaan pelayanan dibatasi biaya kunjungan rawat jalan pada rumah sakit kelas A dan rumah sakit kelas B sebesar Rp 20 ribu untuk satu kali kunjungan. Untuk rumah sakit kelas C, D dan klinik utama Rp 10 ribu.

Aturan ini juga membatasi jumlah biaya paling tinggi untuk kunjungan rawat jalan sebesar Rp 350 ribu untuk maksimal 20 kali kunjungan dalam jangka waktu 3 bulan.

Permenkes ini juga mengatur pembatasan biaya yang ditanggung oleh peserta rawat jalan sebesar 10% dari biaya yang dihitung dari total tarif Sistem Indonesia Case Base Groups (INA-CBG) atau tarif layanan kesehatan yang dipatok pemerintah atau paling tinggi Rp 30 juta.

Dalam beleid ini, Kemenkes membolehkan peserta BPJS Kesehatan yang melakukan rawat jalan untuk naik kelas ke layanan eksekutif yang menggunakan dokter spesialis dengan membayar paket rawat jalan eksekutif paling besar Rp 400 ribu untuk setiap rawat jalan.

Dalam aturan ini, rumah sakit diwajibkan untuk memberitahukan dan mendapat persetujuan dari peserta BPJS Kesehatan tentang kesediaan menanggung selisih biaya. Aturan ini tidak berlaku untuk peserta penerima bantuan iuran (PBI) dan penduduk yang didaftarkan pemerintah daerah. (sumber)

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