The lawyer named ways to deal with refusals of compulsory medical insurance examination

Refusal to conduct an examination under the compulsory medical insurance policy under the pretext of the absence of coupons is illegal, and the patient has the right to request medical assistance within the time limits established by law. Alyona Pustovalova, senior lawyer at the Oncologica Charitable Foundation, told Izvestia on February 9.

"Compulsory medical insurance is an insurance mechanism, not a form of charity. The terms of assistance are clearly stipulated in the law. The lack of coupons, a doctor's vacation, or equipment failure are organizational difficulties of a medical institution that cannot be passed on to the patient," the lawyer emphasized.

According to her, the waiting time limits are set by the State Guarantees Program. From the moment of receiving the referral, the patient must have an appointment with a specialist, undergo ultrasound, X-ray or tests no later than 14 working days later. The same period applies for CT and MRI scans. If an oncological or cardiovascular disease is suspected, the time limit is reduced to seven working days, and a consultation with a specialist doctor should be organized within three days. If the clinic cannot conduct the study on time, it is obliged to issue a referral to another institution.

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Pustovalova noted that in practice, refusals are often related to the financing system.

"It's easier for the clinic to stretch the queue than to redirect the patient, because in this case the money for the examination will go out of its budget," she explained.

The lawyer recommends not to conflict with the registry, but to immediately call your insurance company. Sometimes one competent call is enough for the system to start working.

If the call does not help, the next step should be to send a written request to the chief physician with a request to ensure an examination within the legal time limit or to issue a referral to another clinic. In most cases, the issue is closed as soon as the violation is documented, the expert noted.

She also commented on the opportunity to undergo an examination for a fee, followed by a refund.

"This option requires proof that the paid service was a forced measure, not a voluntary choice, and that you tried but could not get help for free. A patient in the compulsory medical insurance system is an insured person with specific rights, the protection of which through official channels almost always gives results," explained Pustovalova.

On January 9, the chief physician of the Health Strategy clinic network, internist Dmitry Demidik, announced that starting in 2026, Russians will undergo medical examinations according to the new rules, including screenings for viral hepatitis and HPV. According to him, medical examinations are currently aimed at the reproductive function of the body.

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