Free video consultation | Wednesday 11 June
The next session will be on
Wednesday 11 June 2025
With Dr. Andreas Koch
EU Cross Border Directive
Reimbursement for treatment in our clinics
If you are a resident in Ireland and covered by the Health Service Executive (HSE), you have the right to seek planned medical care within the EU/EEA and apply for reimbursement through HSE for operations at our clinics. This allows you to choose a non-mesh hernia repair that’s right for you, while still benefiting from Ireland’s reimbursement system for healthcare abroad.
Your right to EU healthcare reimbursements
Under EU laws on cross-border healthcare, you have the right to seek planned medical care in another EU or EEA country and request reimbursement for the costs. This law ensures that you can access healthcare that addresses your medical needs, even if you choose to receive treatment outside of Ireland.
For treatments like non-mesh hernia surgery at BioHernia, this means you can receive high-quality care abroad while still benefiting from Ireland’s healthcare system.
In simple terms:
- You have the right to choose where you receive your care within the EU.
- You can apply for reimbursement afterward, ensuring the financial burden is minimised.
Legal Reference:
The right to seek planned healthcare abroad and apply for reimbursement is based on the EU Directive 2011/24/EU on the application of patients’ rights in cross-border healthcare.
Criteria for reimbursement
To receive reimbursement for planned medical care abroad, you must meet the following basic criteria:
Eligibility under the Irish healthcare system
You must be eligible under the Irish healthcare system. Most residents holding a PPS number and eligible for public healthcare qualify.
Medically necessary treatment
The treatment must be a medically necessary service. This means the treatment must align with what would be covered under the public healthcare system in Ireland, such as hernia surgery.
Referral or medical recommendation needed
A referral or medical recommendation is required. Your GP or consultant must confirm the medical need for the treatment.
The application process
Follow these steps to receive a reimbursement under the HSE’s Cross-Border Directive scheme:
Seek prior approval (optional)
Prior notification (also referred to as prior authorisation) is optional for treatments that do not involve an overnight stay, such as day-case procedures like our inguinal & umbilical hernia repairs. However, if your treatment requires an overnight stay, such as some complex operations like mesh removals, the HSE advises obtaining prior authoristion. This ensures that your eligibility for reimbursement is clear before treatment and can help avoid potential issues later.
Undergo treatment and collect documentation
You will pay upfront for your surgery at one of our clinics. After the procedure, we provide all the necessary documents, including:
- A detailed invoice with proof of payment
- An operation report summarising the treatment provided
Submit your application
Once you’ve collected your documentation, submit your reimbursement request to the HSE. Applications can be completed:
- Online: Via the HSE Cross-Border Directive portal
- By Post: If you prefer mailing physical documents
Receive reimbursement
The HSE will assess your application and calculate the reimbursement based on the equivalent cost of the treatment in Ireland. If additional details are needed, they will contact you directly.
Frequently asked questions
1. How much of the cost will be reimbursed?
The reimbursement amount will depend on what the equivalent treatment would cost within the Irish public healthcare system. Since individual cases can vary, we advise all patients to apply for prior authorisation through the HSE before undergoing treatment. This ensures clarity on reimbursement and avoids any surprises afterward.
2. Is prior approval mandatory?
For standard procedures like inguinal or umbilical hernia surgery, prior approval is not required. However, for surgeries not commonly performed in Ireland, such as mesh removal, obtaining prior approval from the HSE is highly recommended.
3. How long does it take to receive reimbursement?
Processing times vary. Typically, the HSE aims to process applications within a few months, but timelines can depend on the volume of requests. Contact the HSE directly for the most accurate timeframe.
4. What documents are required?
You’ll need:
- A referral or medical certificate from your GP confirming your diagnosis.
- A detailed invoice and proof of payment (provided post-treatment).
- An operation report summarising your care (also provided by us).