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Specialized Referral
Specialized Referral
Specialized referral is a system that allows patients who are eligible for government-funded medical care to receive treatment at specialized hospitals when, based on a specialist’s opinion and considering the medical staff, facilities, and equipment of the relevant VHS Hospital, it is determined that treatment at the VHS Hospital is difficult.
- Eligible Persons : Among those eligible for full government coverage of medical expenses at VHS Hospitals (excluding those eligible for reduced-cost treatment)
- A patient with an infectious disease, or suspected of having an infectious disease, who cannot be appropriately treated within the VHS Hospital
- Treatment at the VHS Hospital is difficult due to a rare, intractable, or severe disease
- Treatment is difficult due to the absence of a medical department or insufficient facilities at the VHS Hospital
However, those who registered after July 1, 2012 and were classified as Disability Grade 7, and those who registered after June 23, 2016 and were classified as having mild potential aftereffects of defoliants (including second-generation), Grades 12–14 among individuals injured in the May 18 Democratization Movement, and Grade 7 among persons injured while performing a special mission, are required to pay 10% of medical expenses when receiving treatment at medical institutions other than their designated hospital for injury treatment.
Specialized Referral Treatment Procedure
If the attending physician determines after examination that treatment at the VHS Hospital is not possible, referral for specialized treatment is permitted only with the approval of the hospital director.
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Treatment
STEP 01
Treatment at a VHS Hospital
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Decision on Specialized Referral
STEP 02
If treatment is not possible at the VHS Hospital, the attending specialist issues a Specialized Referral Medical Treatment Application
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Referral Information
STEP 03
Guidelines for referral treatment (referral team), scope of support, and claim procedures
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Treatment and Billing
STEP 04
Individual medical expense claims, receipts, detailed statements, etc.
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Review of Medical Expenses
STEP 05
Review of claimed medical expenses (Review Division)
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Payment of Medical Expenses
STEP 06
After the review of claimed medical expenses is completed, the finalized amount is transferred to the individual’s designated bank account
Request for Payment of Medical Expenses
After making payment in advance to the designated medical institution or pharmacy, please prepare the following documents and submit your application:
- 01Original receipt for medical expenses
- 02Detailed statement of medical expenses
- 03Original receipt for prescription drugs (attach the prescription)
- 04Diagnostic results for special examinations (e.g., CT, PET-CT, MRI, ultrasound) for outpatient visits
- 05Verification of use of a higher-level hospital room
- 06Bank account in the applicant’s real name (for receiving pension)
Medical Expenses Not Covered During Specialized Referral Treatment (Detailed information will be provided separately at the time of referral application.)
- 01Medical expenses (or examination fees) for conditions not referred by the VHS Hospital, or expenses for treatment beyond the approved period
- 02Medical expenses incurred due to the patient or guardian voluntarily changing the medical institution
- 03Arbitrary non-covered medical expenses not specified under the Standards for National Health Insurance Benefits
- 04Room rate difference for using a higher-level hospital room (only recognized for up to 7 days from the start of hospitalization when the standard room is unavailable; excludes special/private rooms)
- 05All costs related to the donor incurred during long-term organ transplant surgery
- 06Items classified as non-covered under Article 9, Paragraph 1 of the Regulation on National Health Insurance Care Benefits
- 07Costs for dental prosthetic materials, assistive devices, issuance fees for medical certificates, nursing care fees, telephone charges, medical supplies purchased from specialized medical supply companies or shops, and materials purchased outside domestic medical institutions or pharmacies
- 08Other cases as separately determined by the Minister of Patriots and Veterans Affairs
Responsible Officials by Jurisdiction
| Jurisdiction | Contact Information | |||
|---|---|---|---|---|
| Designated Contracted Services |
Contracted Fee-Reduction Services |
Specialized Referral | Emergency Referral | |
| VHS Medical Center | +82-2-2225-1511 | +82-2-2225-1961 | +82-2-2225-1196 | +82-2-2225-1903 |
| Busan | +82-51-601-6720 | +82-51-601-6150 | +82-51-601-6132 | +82-51-601-6155 |
| Gwangju | +82-62-602-6062 | +82-62-602-6071 | +82-62-602-6065 | +82-62-602-6934 |
| Daegu | +82-53-630-7034 | +82-53-630-7045 | +82-53-630-7028 | +82-53-630-7026 |
| Daejeon | +82-42-939-0187 | +82-42-939-0204 | +82-42-939-0186 | +82-42-939-0287 |
| Incheon | +82-32-363-9722 | +82-32-363-9728 | +82-32-363-9722 | +82-32-363-9727 |
