Too long to see a doctor? NFZ will pay you back for private medicines

Long months of waiting for a specialist visit are frustrating reality for millions of Poles. Many patients, incapable to wait, decide to make a private visit and buy medicines independently. However, it turns out that in certain situations The National wellness Fund is obliged to reimburse the costs incurred. It's a law that fewer people know about and can save their home budget. The key is to prove that the public wellness strategy was incapable to supply medically justified treatment.

The rule is simple, although its enforcement requires cognition of procedures. If the deadline set by the NFZ contract service is so distant that continued treatment or starting treatment becomes impossible or threatens to worsen your health, the patient gains a powerful argument. In 2025, with increasing awareness of patients' rights, more and more people decide to fight for their own. In this article, step by step, we explain how to apply effectively for a refund for medicines and visits that you should not wait for.

It's a amazing law you don't talk out about. erstwhile does NFZ gotta pay?

The legal basis for applying for reimbursement is Public-funded healthcare provision Act and the patient's right to receive benefits in due time. The concept of a medically justified word is crucial. This means that if the first contact doctor issues an urgent referral and the nearest available time for an NFZ specialist is in a fewer months, the patient's rights are infringed.

In specified a situation, the patient is entitled to treatment in another European Union country under the cross-border directive, but besides to search assistance in Poland outside the public strategy and then to search a refund. The NFZ is obliged to reimburse costs up to the limit of financing of the benefit in Poland. This means that if the visit to the cardiologist under the agreement with the NFZ is valued at PLN 150 and the patient paid PLN 300 privately, he can number on a return of PLN 150. The same applies to medicines prescribed during specified a visit.

It is worth noting that the Fund will analyse each case individually. The best chance of a affirmative examination of the application is for patients whose wellness position required immediate interventionand the public strategy was incapable to supply it. Medical documentation confirming the urgency of the case is absolutely crucial here.

Step by step: How to apply for reimbursement for medicines?

The procedure for recovering money from the NFZ requires the thoroughness and gathering of applicable documents. By acting methodically, you importantly increase your chances of success. Here is simply a simplified procedure to be applied in 2025:

• Step 1: paper inability to treat in NFZ. Before you go to a private visit, effort to set up a fewer facilities with a contract with NFZ. Request written confirmation of the first free time. This will be your proof that the strategy was inefficient.
• Step 2: Private visit and prescription. Go on a private visit to a doctor. Make certain you receive Name invoice for consultationNot just a receipt. Your doctor should place an e-recept on the essential medicines.
• Step 3: Buy your medicine and keep your acquisition proof. erstwhile completing a prescription in the pharmacy, besides ask for Name invoice. It's a key paper that confirms who and what drugs he bought. The fiscal receipt itself may be considered insufficient.
• Step 4: Complete and apply. Prepare an authoritative request for reimbursement, addressed to the manager of the provincial branch of the NFZ competent for your place of residence. Join the application with all papers collected.

What papers are necessary? Prepare to Avoid Mistakes

The devil is in the details, and in the case of NFZ formalities – in the completeness of the documentation. Formal shortcomings are the most common reason for rejecting applications. To avoid this, make certain that your application includes all of the following attachments:

Checklist of papers to request reimbursement:

• Request for reimbursement – must contain your individual data, PESEL number, justification (description of the situation with long expectation) and bank account number to refund funds.
• Original referral to a specialist (if required).
• Original name invoices – both for a private visit and for medicines purchased. We emphasize: invoices, not receipts!
• Copy of the prescription or e-recept information printout.
• Medical documentation from a private visit confirming the diagnosis and the request to take prescribed medicines.
• Evidence confirming long waiting time to visit the NFZ (e.g. prints from the e-registration system, business notes from telephone calls with dates and surnames).

The submission of a complete set of papers importantly accelerates the process of examining the application and minimises the hazard of calling for deficiencies, which could extend the full procedure for further weeks.

It's not just drugs. What else can you apply to the NFZ?

The reimbursement mechanics is not limited to medicines. The same rule applies to another medical services which the NFZ was incapable to supply within a reasonable time. Patients successfully apply for a refund for privately performed diagnostic tests, specified as MRI, CT scan, or specialized blood tests, for which you gotta wait for months in the public system.

It is besides possible to recover any of the costs for rehabilitation or tiny outpatient procedures. The same rule is always crucial: you gotta prove that the provision was essential from a medical point of view, and the waiting time within the NFZ posed a threat to your wellness or prevented you from returning to fitness. It's worth remembering that NFZ will reimburse costs only up to its own valuation the benefit concerned. Nevertheless, the recovery of even part of the amount spent provides real support to the patient's portfolio, forced to usage private healthcare.