Costs/Copay using BPJS, real life examples

[Jaime C]

Both cases are for older Indonesians in their late 60’s.

First case: I posted recently about my mother in law, getting cataract surgery using her basic BPJS coverage. Other than taking almost all day waiting at the hospital, everything was successful. She will get her second eye surgery soon, I hope.

It took her about a month after being diagnosed to have the operation, in Bandung. They need at least 10 patients to sign up, as they rent the specialized equipment for the day.

$0 cost to patient for exams or procedure, or medicine. She got scared because she got a story of a botched operation, but we persuaded her to get it done.

Second case: My father in law had a brain aneurysm 5-6 years ago, that mostly incapacitated him. We had a special bed set up for him, and hired a nurse to live in the house to help my MIL care for him.

Near the end of March, while I was in Jakarta with my wife and daughter, he suffered another stroke. My wife returned and got him admitted to the hospital in Bandung. The government one near PVJ mall.

He was there for about 10 days. He had the basic BPJS coverage. Sadly, he worsened, and passed away. Initially they quoted additional costs of 16 juta. Asking what was covered by BPJS, it then became $0.

We did have to pay for a private ambulance to the hospital, IDR 250k. And for his body to be prepared for Muslim funeral, and ambulance transport to Bekasi, 3jt.

 

[serious_fun]

Sorry to read about your family's loss.

 

[jstar]

They need at least 10 patients to sign up, as they rent the specialized equipment for the day.

It makes you hope you’re not the first one they treat that particular day. So they’d have some exercise with the specialized equipment.

 

[Jaime C]

It makes you hope you’re not the first one they treat that particular day. So they’d have some exercise with the specialized equipment.

They seem to have the procedure down pretty well. Might have the second eye done next week.

 

[Jaime C]

My MIL had her second eye done. No problems with the procedure itself, but having to arrive at 5-6am for checkups, and appointments, then wait 4-6 more hours is ridiculous for an almost 70 year old.

After the procedure, after waiting hours at the pharmacy for her medication, and getting yelled at for asking if it’s ready. Only to see the bottle has been finished, and sitting behind the counter for a long time.

 

[scouser59]

In south bali the organisation of bpjs at every stage is pretty good , waiting times are minimal and normally "kick off" around 8 am .
Java of course is another story ,population pressure no doubt.
Some research is required before hand re the quality of the of the doctors to be seen , we have experience of both positive and negative unfortunately .

 

[MamangDudul]

In south bali the organisation of bpjs at every stage is pretty good , waiting times are minimal and normally "kick off" around 8 am .
Java of course is another story ,population pressure no doubt.
Some research is required before hand re the quality of the of the doctors to be seen , we have experience of both positive and negative unfortunately .

I think it is as you said. In Java, especially the Jakarta area of course, there is too much population pressure and the costs for BPJS to cover are kinda exploding. At least you hear a lot more negative storys from that area than from other parts of Indonesia.
In Batam, where I stay, it works pretty flawless and it's even possible to choose the hospital. At least that's my first hand experience and the experience of family members that I know.
Never felt treated bad in any kind of way and doctors did what seemed plausible to me, when I compare it to my time in Europe.

Not every doctor seems like cream of the crop, but many of them do a great job. Of course Iam not a doctor, but with some life experience and many health problems in the family you get a feeling for what seems good and what's not so good.

And yes, most of the important stuff gets covered, no matter what class you have. There are of course some bit morr expensive medications, like Xarelto (for making the blood thinner) which I use, that they don't cover. Anyway that's totally fine, Iam just happy that I can rely on it when it's really needed. Big operations can really put a hole in your wallet.

 

[jstar]

Batam, where I stay, it works pretty flawless and it's even possible to choose the hospital.

Bisakah memilih rumah sakit menggunakan BPJS?​

Saat akan melakukan perawatan kesehatan dengan BPJS, biasanya peserta akan dirujuk untuk mendatangi faskes sesuai kepesertaan.

Akan tetapi, peserta BPJS bisa juga memilih rumah sakit menggunakan BPJS, caranya dengan mengajukan penggantian lokasi rumah sakit.

Namun, proses ini tidak selalu bisa dilalui semua orang. Sebab, untuk bisa ganti rumah sakit rujukan BPJS, kamu harus mendapatkan surat rujukan yang menyebutkan bahwa kamu gagal menemui dokter yang dituju.

Cara ganti rumah sakit rujukan BPJS​

Setiap peserta BPJS sudah ditetapkan untuk mengunjungi rumah sakit tertentu saja. Tapi, peserta diperbolehkan untuk ganti rumah sakit rujukan dalam beberapa kasus, misalnya jika dokter yang ditunjuk sudah tidak bisa menerima pasien baru lagi.

Berikut ini informasi cara ganti rumah sakit rujukan BPJS Kesehatan:

• Datangi faskes tingkat I yang memberikan rujukan
• Serahkan surat rujukan BPJS yang belum digunakan karena gagal menemui dokter yang dituju
• Ajukan penggantian rumah sakit dan berikan alasan jelas mengenai alasan pengajuan
• Apabila pengajuan disetujui, faskes tingkat I akan memberikan surat rujukan ke rumah sakit tipe C
• Jika rumah sakit tipe C yang dirujuk penuh, akan diberi rujukan lain ke rumah sakit tipe B

(Automated) Translation:

Can you choose a hospital using BPJS?

When going to do health care with BPJS, participants will usually be referred to visit the health facility according to their membership.

However, BPJS participants can also choose a hospital using BPJS, by applying for a replacement hospital location.

However, this process is not always passable for everyone. Because, to be able to change to a BPJS referral hospital, you must get a referral letter stating that you failed to see the intended doctor.

How to change the BPJS referral hospital

Each BPJS participant has been assigned to visit only certain hospitals. However, participants are allowed to change referral hospitals in some cases, for example if the appointed doctor is no longer able to accept new patients.

The following is information on how to change to a BPJS Kesehatan referral hospital:

• Go to the level I health facility that provides referrals
• Submit a BPJS referral letter that it has not been used because it was not possible to meet the doctor intended
• Apply for a hospital reimbursement and provide a clear cause for the reason for the application
• If the application is approved, the level I health facility will provide a referral letter to a type C hospital
• If the referred type C hospital is full, another referral will be given to a type B hospital

 

[harryopal1]

Is dialysis covered by BPJS?

 

[jstar]

Is dialysis covered by BPJS?

All kidney disorders are covered, and dialysis also.

 

[MamangDudul]

Bisakah memilih rumah sakit menggunakan BPJS?​

Saat akan melakukan perawatan kesehatan dengan BPJS, biasanya peserta akan dirujuk untuk mendatangi faskes sesuai kepesertaan.

Akan tetapi, peserta BPJS bisa juga memilih rumah sakit menggunakan BPJS, caranya dengan mengajukan penggantian lokasi rumah sakit.

Namun, proses ini tidak selalu bisa dilalui semua orang. Sebab, untuk bisa ganti rumah sakit rujukan BPJS, kamu harus mendapatkan surat rujukan yang menyebutkan bahwa kamu gagal menemui dokter yang dituju.

Cara ganti rumah sakit rujukan BPJS​

Setiap peserta BPJS sudah ditetapkan untuk mengunjungi rumah sakit tertentu saja. Tapi, peserta diperbolehkan untuk ganti rumah sakit rujukan dalam beberapa kasus, misalnya jika dokter yang ditunjuk sudah tidak bisa menerima pasien baru lagi.

Berikut ini informasi cara ganti rumah sakit rujukan BPJS Kesehatan:

• Datangi faskes tingkat I yang memberikan rujukan
• Serahkan surat rujukan BPJS yang belum digunakan karena gagal menemui dokter yang dituju
• Ajukan penggantian rumah sakit dan berikan alasan jelas mengenai alasan pengajuan
• Apabila pengajuan disetujui, faskes tingkat I akan memberikan surat rujukan ke rumah sakit tipe C
• Jika rumah sakit tipe C yang dirujuk penuh, akan diberi rujukan lain ke rumah sakit tipe B

(Automated) Translation:

Can you choose a hospital using BPJS?

When going to do health care with BPJS, participants will usually be referred to visit the health facility according to their membership.

However, BPJS participants can also choose a hospital using BPJS, by applying for a replacement hospital location.

However, this process is not always passable for everyone. Because, to be able to change to a BPJS referral hospital, you must get a referral letter stating that you failed to see the intended doctor.

How to change the BPJS referral hospital

Each BPJS participant has been assigned to visit only certain hospitals. However, participants are allowed to change referral hospitals in some cases, for example if the appointed doctor is no longer able to accept new patients.

The following is information on how to change to a BPJS Kesehatan referral hospital:

• Go to the level I health facility that provides referrals
• Submit a BPJS referral letter that it has not been used because it was not possible to meet the doctor intended
• Apply for a hospital reimbursement and provide a clear cause for the reason for the application
• If the application is approved, the level I health facility will provide a referral letter to a type C hospital
• If the referred type C hospital is full, another referral will be given to a type B hospital

Interesting. Never needed any letter or whatsoever.
I even once said I don't like this particular hospital and asked them if I can choose the one like. So far it was never a problem.
That being said, most hosptials here are ok, 2 are especially good. I've seen every hospital so far, due to visits with family members. Personally I usually only need 3 routine check ups a year.

 

[harryopal1]

All kidney disorders are covered, and dialysis also.

Thank you.

 

[jstar]

Interesting. Never needed any letter or whatsoever.
I even once said I don't like this particular hospital and asked them if I can choose the one like. So far it was never a problem.
That being said, most hosptials here are ok, 2 are especially good. I've seen every hospital so far, due to visits with family members. Personally I usually only need 3 routine check ups a year.

Yeah, the infamous ‘theory vs reality’ dilemma.

We‘ve seen (and had) quite some good results in Carolus (JakPus). I’m not familiar with the (new) one in Sumarecon, think the family there goes to Bethsaida.

 

[pantaiema]

Foreigners living in Indonesia with KITAP / KITAS

1. Their residencies are sponsored by the OH (wife/husband). Are they eligible for BPJS ?? If yes is the premium the same with other Indonesian People with the same classes or different ??

2. If the sponsor is other Indonesian people (not wife/husband), for instance parents, siblings, friends, Are they also eligible for BPJS ??

Any information especially personal own experience link to authoritative source will be very much appreciated.

 

[fastpitch17]

Foreigners living in Indonesia with KITAP / KITAS

1. Their residencies are sponsored by the OH (wife/husband). Are they eligible for BPJS ?? If yes is the premium the same with other Indonesian People with the same classes or different ??

2. If the sponsor is other Indonesian people (not wife/husband), for instance parents, siblings, friends, Are they also eligible for BPJS ??

Any information especially personal own experience link to authoritative source will be very much appreciated.

1. Wife WNI wife sponsored and pay the same rate according to Class enrolled in. Never seen any prices different than the standard for the 3 classes. There are differences if opinions in various BPJS offices if a non working foreigner can enroll. You need to contact your local BPJS office and see which side of the fence they sit.

2. Not sure but those sponsored by work would be enrolled through their employer. I believe that us mandatory.

BPJS does have a web site.

 

[yantiharun1]

Foreigners living in Indonesia with KITAP / KITAS

1. Their residencies are sponsored by the OH (wife/husband). Are they eligible for BPJS ?? If yes is the premium the same with other Indonesian People with the same classes or different ??

2. If the sponsor is other Indonesian people (not wife/husband), for instance parents, siblings, friends, Are they also eligible for BPJS ??

Any information especially personal own experience link to authoritative source will be very much appreciated.

2. I have Kitap and my sponsor is my sister (WNI).
I went to Kantor BPJS Kesehatan in Jalan Raya Pasar Minggu, Jakarta Selatan. Filled out the necessary registration form. I was surprised that the whole process only takes not more than 1-1/2 hr. I was given my own BPJS no. and two weeks after that I went back to BPJS to pick up my BPJS card. Everyone was so pleasant and helpful. You do need to have Kartu Keluarga.

 

[MamangDudul]

Foreigners living in Indonesia with KITAP / KITAS

1. Their residencies are sponsored by the OH (wife/husband). Are they eligible for BPJS ?? If yes is the premium the same with other Indonesian People with the same classes or different ??

2. If the sponsor is other Indonesian people (not wife/husband), for instance parents, siblings, friends, Are they also eligible for BPJS ??

Any information especially personal own experience link to authoritative source will be very much appreciated.

1.
After going to the office often enough and after my KTP OA was online in the system (although i don't know if there was a connection cause so far my NIK is still not visible), it suddenly worked.
In my eyes it's a bit tricky and there is no real clear statment if a foreigner on spousal KITAS/KITAP is actually eligible or not. Often BPJS just says no or you get 10 different answers from 10 different employees. The hotline tells you something different from the workers in the office and so on.

From all that I heard and experienced it's gotten harder for foreigners to get into BPJS. If you are eligible or not depends pretty much on how they wanna see it and who you deal with. For me it doesn't really get clear from the rules alone. Theoretically one should be eligible but at the same time not.
Unless something changed recently and we have clear rules that everyone follows the same way.
It also depends if your wife/husband works or not. If she works you could be on her KK and benefit from the BPJS that she gets from her company.

Sorry that I can't really help you with this. I think people just have to try their luck.

Ps: if it works, the prices are the same as for local people.

 

[Hawk256]

I was told no muliple times when I tried to sign up even with a KITAP so I gave up on it. Other people were getting it but I was told no. My wife already had it so after we moved I went to the new BPJS location after getting all of my documents changed. Instead of asking to sign up, I told them that I wanted to be added to my wife's BPJS. Was done that day and 2 days later had a card. From what I can tell, if you ask them (and/or your wife doesn't have it) the answer will be no. If you tell them to add you to your wife's, they will do it. Still haven't needed to use it and hopefully I won't have to but it is there now. Seperate issue but I'm still not sure my NIK is in the system. 5 years you think would be enough. Had to be manually added for vaccination and was told last year that I couldn't open a new bank account until they fixed it. The BPJS add on was after that so I assume it is fixed.

 

[fastpitch17]

was told last year that I couldn't open a new bank account until they fixed it.

I inquired at my wife's bank about making deposits for her and they asked for my KTP. Funny, all my information is there all registered properly but bank says can't do anything because my picture does not show up. Oh well, more ATMs take deposits now so no need to walk into the bank.

 

[pantaiema]

I have come across several cases recently where foreigners holding ITAS/ITAP have applied for 'BPJS Kesehatan,' but the outcomes have been mixed, with more applications seemingly being rejected nowadays. I understand that 'BPJS Kesehatan' is mandatory for foreigners on employment contracts, foreign students, but my question does not pertain to these groups. I am also aware they have discretion to accept the people.

Does anyone know of any laws or regulations that specifically address the entitlement of foreigners with ITAS/ITAP (but without an employment contract) to 'BPJS Kesehatan'? If so, could you please cite the relevant article, so we could learn it?