Arriving directly to the emergency room (without a referral)
One is entitled to receive treatment in the emergency room (ER), without a need for a proper medical referral. Israel's Ministry of Health has outlined various criteria for which the cost of these ER treatments are settled directly between the medical center, and the health care provider (Kupat Cholim) of the patient.
There are multiple medical circumstances in which a patient with medical coverage from any of the health care providers (Kupat Cholim) can arrive directly to the emergency room, without any medical referral or payment commitments (hitchayvut) from the health care provider.
The circumstances include:
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Treatment of any injury which involves stitches
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A new broken bone
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Elbow and/or shoulder dislocation
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Foreign object in the eye
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Foreign object caught in respiratory track
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Labor contractions
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Treating hemophilia
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Treating cystic fibrosis
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Dialysis patients
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Fever (over 38.5C) for a newborn (up till 2 months old)
In any of the events outlined above - the charge for the ER treatment will be settled directly between the medical center, and the health care provider (Kupat Cholim) of the patient.
Arriving directly to the emergency room with a medical referral
When a patient arrives at the ER with a signed medical referral from a doctor (good for 24 hrs.) - the payment for the emergency room treatment will settled directly between the medical center, and the health care provider (Kupat Cholim) of the patient, without any need to provide a payment commitment (hitchayvut).
That said, the health care provider reserves the right to appeal, on the grounds that the treatment provided did not meet any of the criteria outlined above. As such, the patient must sign a document stating that in the event that the health care provider refuses to pay for the ER treatment - the patient will be responsible for the payment for the ER visit (either via direct payment, or through a payment commitment from the health care provider).
Below you'll find the Ministry of Health's payment guidelines for patients with insurance from a health care provider:
