BPJS Health Does Not Cover 144 Diseases, Here Are the Facts

Kapanlagi.com - Recently, the public has been stirred by information stating that BPJS Kesehatan will not cover treatment costs for 144 types of diseases. This news has certainly caused panic, especially among participants who rely on this health insurance to meet their medical needs. But is this issue true?

Quickly, BPJS Kesehatan responded to the circulating news through various platforms, including social media. After clarifying, they emphasized that the information regarding the 144 diseases not covered is a hoax. BPJS Kesehatan also explained the coverage scheme for the list of diseases in question.

Here is a complete explanation from BPJS Kesehatan regarding this issue, summarized by Kapanlagi.com on Saturday (1/2).

1. Clarification from BPJS Kesehatan: 144 Diseases Remain Covered, But Managed at FKTP

In an interesting post on Instagram, BPJS Kesehatan (@bpjskesehatan) revealed shocking facts regarding rumors circulating about 144 diseases that allegedly are not covered. "Check the facts, is it true that there are 144 diseases that cannot be referred to a hospital? It turns out, 144 Diseases Cannot Be Referred to a Hospital (cross mark) and 144 Diseases That Can Be Managed by Doctors at FKTP (check mark). Different Words, Different Meanings, Be Careful!" they wrote.

BPJS Kesehatan emphasized that these diseases are still covered under the National Health Insurance (JKN) scheme, but they do not need to be referred to a hospital because they can be managed at primary health care facilities (FKTP) such as community health centers. At FKTP, doctors have the ability to handle various mild to moderate diseases, and will only provide a referral if the patient's condition is more complex.

"According to regulations, there are 144 diseases that can be fully managed by doctors at Primary Health Care Facilities independently and completely. If the patient's condition cannot be managed independently, the treatment costs will still be covered by BPJS Kesehatan," explained the Head of BPJS Kesehatan Branch Surabaya, Hernina Agustin Arifin.

2. What Are the 144 Diseases Treated at FKTP?

BPJS Kesehatan does not publish a detailed list of the complete 144 diseases treated, but based on existing regulations, there are several common diseases that can be addressed at the First Level Health Facility (FKTP). These include febrile seizures, tetanus, HIV/AIDS without complications, tension headaches, migraines, Bell's palsy, vertigo, somatoform disorders, insomnia, and various eye problems such as foreign bodies in the conjunctiva and conjunctivitis.

These diseases still receive services from BPJS Kesehatan, and interestingly, patients do not need to be directly referred to a hospital because doctors at FKTP are skilled in handling these cases comprehensively.

3. What If a Patient Needs a Referral to a Hospital?

The BPJS Kesehatan system implements a tiered regulation that requires patients to receive care at the First Level Health Facility (FKTP) before they can be referred to a hospital. However, there are times when patients can directly receive a referral, such as when their health condition does not improve, the disease worsens, or they require more complex medical care and equipment that is not available at FKTP.

In this situation, doctors at FKTP will provide an official referral letter so that patients can continue their treatment at a hospital partnered with BPJS Kesehatan, without additional costs. Unfortunately, in practice, there are still many obstacles, such as participants' reluctance when asked to be hospitalized, indicating that their condition may not yet be classified as an emergency, as expressed by Hernina Agustin in her interview with RRI.

4. Reasons Why 144 Diseases Are Addressed in FKTP

In the midst of efforts to improve health services, there are strong reasons why 144 diseases must be addressed first at the First Level Health Facility (FKTP) before being referred to hospitals. First, this step will create service efficiency, preventing hospitals from overcrowding with patients who only have mild illnesses that can actually be resolved at community health centers or clinics.

Additionally, doctors at FKTP have the competent ability to handle various mild to moderate medical cases, making their role very vital.

By reducing the burden on hospitals, these health institutions can focus more on handling more complex and serious cases. Not only that, this system also improves access to health services for JKN participants, allowing them to receive medical care more quickly without getting stuck in long queues at hospitals.

5. BPJS Health Asks the Public Not to Fall for Hoaxes

BPJS Health reminds the public not to get caught up in news that circulates without first verifying it. Recently, there has been a misunderstanding regarding 144 diseases that are claimed not to be covered by BPJS, which is actually not true.

To obtain accurate information, JKN participants are advised to refer directly to official BPJS Health sources, such as the website, the Mobile JKN application, or their official social media accounts. BPJS Health also emphasizes that services for JKN participants are still available and all participants will continue to receive their rights according to applicable regulations.

6. Is it true that 144 diseases are not covered by BPJS Health?

Of course, there is good news! A total of 144 diseases are still covered by BPJS Health. However, to receive the appropriate treatment, patients must first undergo treatment at a First Level Health Facility (FKTP). If necessary, they will then be referred to a hospital.

7. Why are patients with these 144 diseases not directly referred to the hospital?

Doctors at First Level Health Facilities (FKTP) have the adequate skills to independently handle various diseases. Referrals to hospitals will only be made if the patient's condition exceeds the handling capacity available at FKTP, ensuring that every patient receives appropriate and efficient care.

8. How can I find out if my disease is included in the list of 144 diseases?

Although BPJS Kesehatan does not provide an official list of diseases in one document, you can find various conditions that are generally treated at First Level Health Facilities (FKTP). From mild infections, uncomplicated hypertension, to controlled diabetes and mild skin diseases, FKTP is ready to assist you.

9. How can I obtain a referral to the hospital if I need one?

Doctors at the First Level Health Facility (FKTP) will provide referrals to patients who require further treatment at the hospital. To ensure you continue to enjoy all the benefits of BPJS Health services, it is important to follow the established procedures.

(kpl/srr)