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Name of Policy/Procedure or Guidance                      Overseas Visitors Policy


Date issued:                                              Dec 05


Date to be returned:                                      Dec 08

                                                          Simon Marshall – Director of Finance
Lead/comments to be returned to                           Andy Finlay – Income Generation Manager


4     Record of Amendments
Amendment      Date               Detail                                                         Page               Paragraph
No.                                                                                              No(s).             No(s).
1              June/July          Insertion of the three consultants rule for                    25
               2006               discharge when stable.
               July 2006          Insertion of clause with regard to other                       37
2                                 government departments failing in their
                                  statutory duty.
               Jan 2007           Romania & Bulgaria added to EU                                 46
3                                 regulations
4              Jan 2008           Reviewed by LCFS, additional sentence to                       30,
                                  advise that it is a criminal offence to                        Appendix
                                  provide incorrect or misleading information                    1, Part C
                                  on the form. Strengthen the wording to
                                  include LCFS & Police action
               Jan 2008           First paragraph, stage 2 interview,                            31,
5                                 rewording for readability reasons.                             Appendix
                                                                                                 2,
6              Jan 2008           Finance Use only added to Overseas                             30,
                                  Patient Record form –financial information                     Appendix
                                  record                                                         1
               April 2008         Rewording of Para 7.9 – Stabilise &                            25
7                                 Discharge Protocol.
               April 2008         Addition of para 5.6 – 18 week wait                            21
8




                                                                                            Overseas Visitors Policy
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                                                                                                      Andrew Finlay
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                                                  1
                                                                           Overseas Visitors Policy
Name of Policy, Procedure or Guidance


Reference Number (to be inserted by
Intranet Manager)

                                                             All Medical Staff, Admin & Clerical Staff,
Who should read the objectives of this                       Finance Staff, Nursing Staff, Associate
policy/procedure                                             Directors, Directors


Executive Summary                                            Correctly identify those patients who do not

                                                             normally reside in the UK, who seek treatment at

                                                             WMUH and issue charges to protect Trust

                                                             Resources.


Committee & date approved


Ratified by Trust Board on:                                  (only insert date if appropriate)

                                                             Dec 2008
Review Date

                                                             Simon Marshall – Director of Finance
Director(s) responsible for ensuring this
document is implemented

                                                             Andrew Finlay – Income Generation Manager
For further information contact                              xxxxxxxxx, xxxxxxxxx


The formal/legal documents forming the                       Implementing the Overseas Visitors Hospital Charging
basis of this document are                                   Regulations- April 1989, amended 2004




                                                             NHS Act 1977
Cross reference to




                                                                                             Overseas Visitors Policy
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                                                   2
         Overseas Visitors‟ Policy
West Middlesex University Hospital NHS Trust




                                                                                     Overseas Visitors Policy
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                                                                                               Andrew Finlay
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                                           3
                                           Contents
Section Description                                                                                        Page
1       Introduction                                                                                             3
2       Aims                                                                                                     4
3       The Law in England & Wales                                                                               5
4       The Regulations Explained                                                                                8
5       Procedure for Establishing Eligibility                                                                 15
6       Roles & Responsibilities of Trust Officers                                                             19
7       Procedure for all Interviews                                                                           20


Appendices
1       Overseas Patient Record Form                                                                           27
2       Stage 2 Interview Record                                                                               28
3       Credit/Debit Card Declaration                                                                          29
4       Medical/Holiday Insurance Form                                                                         30
5       But what about….? A-Z of Overseas patients                                                             31
6       Base Line Questions                                                                                    41
7       Quote for Care                                                                                         42
8       EEA and Non-EEA Bilateral Agreements                                                                   43
9       Out of Hours Form                                                                                      44
10      Advice for Medical Practitioners                                                                       45
11      Standard letter to Patients                                                                            46
12      IGA Form                                                                                               47
13      NHS IND Enquiry                                                                                        48




                                                                                           Overseas Visitors Policy
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                                                 4
1. Introduction

1.1       The National Health Service (NHS) provides healthcare free of charge to

          people who are resident in the United Kingdom. People who do not

          usually live in the UK are not automatically entitled to use the NHS free

          of charge. Residency is therefore the main qualifying criterion,

          applicable regardless of nationality or whether the person holds a British

          Passport, or has lived and paid taxes or National Insurance

          contributions in the UK in the past.

1.2       This policy is concerned with the management of individuals who do not

          normally live in the UK, (overseas visitors), when they seek treatment

          from West Middlesex University Hospital NHS Trust (WMUH). It is

          commonly accepted that the Trust fails to identify all such patients and

          manage them accordingly. This not only represents lost revenue to the

          organisation, but moral and ethical dilemmas for clinicians and

          managers alike.

1.3       The charging regulations as directed by the Department of Health

          (Implementing the Overseas Visitors Hospital Charging Regulations-

          April 1989, amended 2004) place a legal obligation on NHS Trusts in

          England to establish if people to whom they are providing NHS hospital

          services are not normally resident in the UK. If they are not then charges

          may be applicable for NHS services provided. When that is the case

          the Trust must charge the person liable (usually the patient) for the

          costs of the services.




                                                                                        Overseas Visitors Policy
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2. Aims

         This policy describes a standardised Trust wide procedure that will be

          considered „Best Practice‟ for the management of Overseas Visitors

         It will eliminate discrimination and achieve parity for all patients of West

          Middlesex University Hospital NHS Trust

         It will provide guidance and support for operational staff who have

          Admissions privileges

         It should be an organic fluid document that promotes professional

          autonomy whilst protecting Trust finances.




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                                             6
3.      The Law in England and Wales

3.1     All NHS Trusts have a statutory obligation to establish whether people using

        their services are normally resident in the UK. The Trust‟s statutory duty

        extends to charging those who are found not to be eligible for free treatment,

        and who are not otherwise exempt or covered by a Reciprocal Healthcare

        Agreement or European Economic Area arrangements (EEA). If the Trust is

        satisfied that the patient is liable to pay, the law requires the Trust to calculate

        and recover the charges for any treatment given.

3.1.1   The law is not optional and nor do the Trust or the Chief Executive have

        the authority to waive the charges. Only the Secretary of State can, in special

        cases agree to waive charges.

3.1.2   The Trust is also required to inform the Department of Health if it provides

        services to a patient from one of the countries with which the UK holds a

        Reciprocal Healthcare Agreement or from one of our EEA partner States. This

        information is needed at a national level to maintain those agreements and to

        ensure that they remain fair to the UK and other partners.

3.1.3   The statutory provisions which enable overseas visitors to be charged for NHS

        treatment are found in section 121 of the National Health Service Act 1977 (as

        amended by sections 7(12) and (14) of the Health and Medicines Act 1988).

        These give authority to the Secretary of State for Health to make regulations

        concerning charging anyone who is not ordinarily resident in Great Britain for

        any NHS services provided. They also give him powers to calculate such

        charges on any appropriate commercial basis. These powers are devolved to

        Health Authorities and NHS Trusts.

3.1.4   Using the powers in section 121 Parliament has approved regulations

        exempting some people and some services from charges. These exemptions

        are list in Appendix 8.

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3.2   Amendments to The National Health Service (Charges to Overseas Visitors)

      Regulations

         The National Health Service (Charges to Overseas Visitors) Regulations

          1989 (Statutory Instrument (SI) - 306) – the current baseline Regulations;

         The National Health Service (Charges to Overseas Visitors) Amendment

          Regulations 1991 (SI 438) – amended the baseline to reflect the

          introduction of NHS Trusts; introduced exemption for family planning

          services and made changes to the list of bilateral healthcare agreement

          countries

         The National Health Service (Charges to Overseas Visitors) Amendment

          Regulations 1994 (SI 1535) – introduced amendments necessary on the

          creation of the European Economic Area (EEA); removed the dental and

          optical emergency departments from the services exempt from charges;

          made amendments concerned with the European Social Charter and

          amended the list of diseases for which no charge shall be made and the list

          of countries with which we hold bilateral healthcare agreements

         The National Health Service (Charges to Overseas Visitors) Amendment

          Regulations 2000 (SI 602) – amended the baseline Regulations to include

          Primary Care Trusts (PCT’s)

         The National Health Service (Charges to Overseas Visitors) Amendment

          Regulations 2000 (SI 909) – corrected an error in SI 2000/602 which

          omitted a coming into force date

         The NHS (Functions of Strategic Health Authorities and Primary Care Trusts

          and Administration Arrangement (England) Regulations 2002 (SI 2375) –

          placed responsibilities on Strategic Health Authorities to performance

          manage the operation of arrangements made under s121 of the NHS Act

          1977.

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             The National Health Service (Charges to Overseas Visitors) Amendment

              Regulations (SI 614) – amended the baseline Regulations to include the

              changes to Regulations designed to tighten loopholes open to abuse and

              modernise the charging regime.

The Trust may from time to time seek help and advice from the Department of Health

about any aspect of the charging regulations. In the first instance make any enquiries

to the Income Generation Manager for Overseas Patients on xxxxxxxxx or xxxxxxxxx. If

the issue is still unclear advice will be sought from the Department of Health. The

Department cannot intervene in individual cases. The decision about whether an

individual patient is liable for charges rests with the WMUH.



In some cases, perhaps where a patient’s circumstances are unclear or do not appear

to be provided for in the regulations, the WMUH may need to seek its own legal

advice.



However, if there is any doubt then WMUH will make the patient liable for charges and

they can then make a claim to be exempted by providing the necessary information.




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                                                      9
4.     The Regulations Explained

There are ten regulations governing the management of overseas visitors seeking

treatment in the UK.

4.1    Regulation 1

This regulation provides some definitions of the words and terms used in the other

regulations (see glossary included in the A-Z of overseas patients Appendix 5)

Calculating the Period of Residence – The regulation provides that when calculating

a period of residence a person can be out of the UK for up to three months before it is

taken into consideration. For example, if a person has lived in the UK for 12 months

immediately preceding their treatment but has spent three months of that time on

holidays abroad they can still be considered to have spent the last 12 months in the

UK.

Child – for the purpose of the regulation a child is someone under the age of 16, or 16-

19 but in full time education.

Member of Family – this applies only to people from EEA countries.

Overseas Visitors – means any person of any nationality not ordinarily resident in the

UK. Treatment the need for which arose during their visit – this also applies to

treatment needed where the diagnosis of a condition is made when first symptoms

arise during a visit to the UK. It does not include routine monitoring of existing

conditions, e.g. diabetes.



4.2    Regulation 2

This regulation states when and how a Trust should make a charge for treatment and

how it should recover the money.

The regulation places a legal obligation of the Trust to establish if a person is not

ordinarily resident in the UK. The Trust must make reasonable enquiries into the

circumstances of that person to determine if they are liable for charges.

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If, in the light of enquiries the Trust decides that the patient is not eligible for free

treatment then the Trust must levy a charge and recover it from the patient. The

Trust must give the patient or the person paying the charge a receipt for the amount

paid.



4.3     Regulation 3

Some NHS services provided by the Trust are free to everyone regardless of their

status as a patient. These are detailed below:

A&E – Treatment given in an accident and emergency department, a walk-in centre, a

minor injuries area, an A&E clinic or an Observation Ward attached to an A&E

department. This exemption from charges ceases when the patient leaves the area and

is admitted to a ward or given an outpatient appointment. To clarify a common

misconception, emergency treatment is not exempt; the area in which the treatment is

administered is exempt. The same emergency treatment given in ITU is chargeable or

CCU is chargeable.

Community – Some services provided in the community will be chargeable only where

the staff are employed by a Trust, e.g. District Nurses by a PCT. However a Practice

Nurse employed by a GP providing a service is NOT chargeable.

Public Health Protection – There are certain diseases where treatment necessary to
protect the wider public health. They are as follows:
             Acute encephalitis                               Plague
             Acute poliomyelitis                              Rabies
            Amoebic Dysentery                             Relapsing Fever
                   Anthrax                                    Rubella
             Bacillary Dysentery                        Salmonella infection
                   Cholera                         SARS (Severe Acute Respiratory
                                                             Syndrome
                 Diphtheria                                Scarlet Fever
              Food Poisoning                                 Smallpox
                   Leprosy                            Staphylococcal infections
                   Malaria                                    Tetanus
                   Measles                                  Tuberculosis
                 Meningitis                                Typhoid Fever
         Meningococcal septicaemia                            Typhus
            (without meningitis)
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                    Mumps                         Viral haemorrhagic fevers
             Opthalmia neonatorum                        Viral hepatitis
               Paratyphoid fever                      Whooping Cough
                                                         Yellow Fever
Treatment given in, or as the result of a referral from an STD Clinic – This does

not apply to treatment for HIV Positive patients who must pay for any treatment beyond

an initial diagnostic test and any counselling associated with the test or its result. An

overseas visitor with HIV/AIDS referred to a hospital from such a clinic will be liable for

charges unless otherwise exempt.

For example, a Patient with TB & HIV, the treatment for TB will be exempt from

charges, however the patient will still incur charges for the treatment of HIV.

Detained under Mental Health Act – All treatment given to people detained under the

Mental Health Act or a probation court order is exempt.



4.4       Regulation 4

This regulation specifies the circumstances where an overseas visitor may be exempt

from charges:

         Where married couples are concerned, if either the husband or the wife is

          exempt then their spouse and any children under the age of 16 or under 19 if

          they are still in full time education will also be exempt if they are either in the UK

          with the exempt person for the duration of their visit.

         The exemption only applies to spouse and children where the exempt person is

          in the UK with them at the time of treatment. If they are travelling

          independently of the exempt person, then the exemption does not extend to

          them.

         Anyone who at the time of receiving treatment has been resident in the UK for

          the previous 12 months. This is the fundamental qualifier to recognise

          ‘ordinarily resident status.’ (See Base Line Questions Appendix 6)



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                                                      12
                                         Ordinarily Resident

 A person lawfully living in the UK voluntarily and for settled purposes as part of the

regular order their life for the time being. They should have an identifiable purpose for

their residence here and that purpose should have sufficient degree of continuity to be

                                  properly described as „settled‟.



      Anyone who has come to the UK to take up permanent residence.

      Anyone who has come to the UK for employment (self employed or employed

       by others) it is not sufficient to have the right to work here, they must actually be

       in work.

      Students pursuing a full time course of study – minimum six months (at the time

       of treatment are still attending their course) the spouse and children of an

       exempt overseas student will also be exempt provided that they are living with

       the student on a permanent basis for the duration of the course.

      Someone who has entered the UK on a temporary basis, for example on a

       visitors visa, but makes an application to remain in the UK permanently will

       remain liable for charges until application has been granted.

      Anyone who is living lawfully in the UK for 12 months prior to treatment, except

       where the patient originally came to the UK for the purpose of obtaining

       private medical treatment.

      Where a Refugee or an Asylum seeker (A refugee is someone who has been

       granted asylum in this country) has been living in the UK more than 12 months

       and is receiving a course of treatment free of charge and is subsequently

       established that the application has finally failed and exhausted all appeals,

       they cannot be charged for the present treatment but any new treatment must,

       however be charged – Exemption only lasts until their claim is determined and

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          the Trust will check that the application is still on-going regular intervals if

          treatment is being provided over a long period. If the claim is finally rejected

          then any new claim is chargeable. Once they have completed 12 months

          residence they do not become exempt from charges.

         Members of HM Forces and other Crown servants and British Council or

          Commonwealth War Graves Commission staff serving overseas and others

          working overseas under arrangements sponsored by HM Government.

         People working abroad for not more than five years, as long as they have lived

          in the UK lawfully for ten continuous years, will receive immediate necessary

          treatment during their short visits, but if working more than five years they will

          no longer be exempt.

         Seamen working on UK registered ships.

         Those receiving UK war pensions

         Diplomatic staff at embassies and commonwealth high commissions in London.

         EEA nationals working in another EEA member state but paying compulsory UK

          Class I or Class II National Insurance contributions.

         Referred to the UK for specific treatment from EEA countries or Switzerland,

          must have E112 issued by the State Health Authority in their home country.



4.5       Regulation 4a

This concerns people who are in receipt of a UK state pension.

         Pensioners residing in both the UK and another EEA member state – as long as

          they spend ay least six months living in the UK and are not registered as a

          resident in another EEA member state, they remain exempt. This exemption

          does not apply of they are living in a non-EEA member country during the

          period they are away.



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                                                      14
4.6       Regulation 5

This regulation also lists categories of overseas visitors who are exempt from charges.

In this case however, the exemption is limited to treatment needed for conditions

arising during the visit. Under this regulation pre-existing conditions are excluded.

         UK State pensioners who are living in a non-EEA country, who have lived in the

          UK for ten continuous years at some point or have been employed by the UK

          government for ten continuous years.

         Nationals from Turkey who are genuinely without resources to pay for their

          treatment.

         Visitors from non-EEA countries with which we hold bilateral healthcare

          agreements. (see appendix ##)



4.7       Regulation 6

This regulation provides for free treatment to be given to a person who is serving with

an armed force which is part of NATO but only where that treatment cannot be readily

provided by either his or her own medical force or the UK Armed Forces Medical

Services.



4.8       Regulation 6a

This allows the Secretary of State for Health to designate an individual as exempt from

charges on exceptional humanitarian grounds, as long as certain specified criteria are

met. The Secretary of State can only make this designation and the Trust would need

to establish whether such determination has been made.

The patient is allowed to be accompanied by an authorised companion, who will also

be exempt from charges for treatment should the need arise whilst they are in the UK,

but not for other treatment.




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The Trust will be advised that the appropriate determination has been made and that

supporting documentation will be provided (although in an emergency this may arrive

after the patient).



4.9      Regulation 7

This regulation specifies who is liable to pay the NHS charges. In the vast majority of

cases this will be the patient. There are two exceptions:

            Seaman – liability with the owner of the ship.

            Aircrew – liability with the Airline or employer



4.10     Regulation 8

This regulation concerns the repayment of NHS charges. These can be repaid only

where the person who paid them can provide evidence that, at the time they received

the services, they were not liable for the charges. The person has to provide the

Trust with the receipt for the money already paid; a signed declaration in support of his

or her claim and whatever reasonable evidences the Trust requires. Where these

conditions are met, any charges recovered should be repaid. The final decision is with

the Director of Finance for WMUH. The decision made by the Director of Finance is

final.

Treatment provided in A&E, Minor Injuries units and Observation Wards attached to

A&E departments is exempt. The exemption from charge ceases when the patient

leaves the department, i.e. is admitted to a ward within the hospital or is referred to an

outpatient clinic. The common misconception is that „emergency‟ treatment is free, it is

not, it is the location that is exempt not the treatment. Trusts have an obligation to treat

patients who have life threatening conditions and to provide immediately necessary

treatment, irrespective of ability to pay.



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5.     Procedure for Establishing the Patient‟s Eligibility for

       NHS Treatment

5.1         Admission via A&E

There is no exemption from charge for „emergency‟ treatment (other than that given

in an accident and emergency department or an observation ward attached to an

A&E department). WMUH will always provide immediately necessary treatment if it

is to save the patient‟s life. It must not be delayed whilst the patient‟s chargeable

status is determined. Failure to do so is in direct breach of the European

Convention on Human Rights Act 1998.



If a patient has indicated that they are a visitor to the UK or that they are on holiday,

the overseas address must be entered onto Symphony (the A&E PAS system) as

the permanent address and the UK address as the temporary address.



Upon making of the notes, the stage one questionnaire inside the notes must be

filled in and dated, and if found to be liable then a stage two interview with the

Income Generation Manager for Overseas Patients (xxxxxxxxx, xxxxxxxxx) to be

arranged as soon as possible.



5.2         Inpatient Admissions

If the patient is admitted the stage two interview should take place as soon as it‟s

conveniently possible. All patients admitted for a new episode of treatment must

complete the patient registration form, or have the form completed by the

Outpatients Department.


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The patient‟s representative should be asked the stage one questions if the patient

is unable to answer them, an interpreter is to be used from either Language Line or

the Hounslow Interpreting Service. If any patient upon questioning at stage one

indicates that they are a visitor to the UK or are on holiday then they must be

referred to the Income Generation Manager for Overseas Patients as soon as

possible, as it is highly likely that they are liable for NHS charges.

It is imperative that all medical, nursing and admin staff are aware that it is

everyone‟s responsibility to ensure that overseas visitors are correctly identified and

that the appropriate referral to the Income Generation Manager is carried out as

soon as possible.

Staff must refrain from giving advice on eligibility for free treatment and/or

approximate pricing unless the Income Generation Manager has advised them

beforehand.

      Once status has been determined this MUST be entered into Camis:
             Input Patient‟s Hospital Number
             Goto page 2 by pressing F7 to go to next page
             Tab down to Overseas Visitor section
             Press F3 to get a list of options
             Select the correct option (this option will have been determined by the
              stage 2 interview or the Income Generation Manager.)
This must be carried out for every patient



xxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxx, 2nd xxxxxxxxxxxxxxx

and on xxxxxxxxx or xxxxxxxxx, during the hours of xxxxxxxxxx. An out of hours

service to handled by telephoning xxxxxxxx, this is an answer service and will be

dealt with upon the return of the Income Generation to the Finance Department. .



5.3           Outpatient Appointment



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The Outpatients Department has displayed on all of its plasma screens the

requirements and information for all patients what they need to do to prove

exemption status. There is also a poster in each clinic area stating the

requirements. The appointment letter will contain a paragraph explaining to the

patient that they will be required to prove the eligibility to receive free NHS

treatment.

On the day of the appointment, the admin staff must ensure that the baseline

questions are asked as part of the admissions procedure (Appendix 6) If the

answer to the question – Where have you lived for the last 12 months? Is in the UK,

admin staff must be prepared to ask for basic supporting evidence, e.g. a utility bill

bearing their name. If the patient is unable to provide evidence then they must be

referred to the Income Generation Manager on xxxxxxxxx or xxxxxxxxx, during the

hours of xxxxxxxxxx. The patient should be informed that they will be interviewed to

establish their eligibility for free NHS treatment. At this stage the patient should

NOT be booked in until eligibility is established.

This process should be checked regardless of whether the patient has a new or old

set of notes, or the appointment is anew one or a follow up.

In cases where the GP referral letter indicates that the patient has recently arrived

in the UK then a copy of the letter must be given to the Income Generation

Manager. If in the opinion of the medical staff that the appointment is not classed

as immediately necessary treatment, eligibility must be established before any

treatment is given.

A patient who is found to be liable for charges but refuses to pay or is unable to pay

will be discharged from the clinic and referred back to their GP if appropriate and/or

A&E for further advice/treatment. The Income Generation Manager has the

delegated authority from the Director of Finance to perform this function.

   Once status has been determined this MUST be entered into Camis:

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            by pressing F7 to go to next page
            tabbing down to Overseas Visitor section
            pressing F3 to get a list of options
            Selecting the correct option
This must be carried out for every patient



When a patient is referred to the Income Generation Manager on the basis of a GP

referral letter, before the appointment date standard letter is sent to the patient

(Appendix 11). If no response is received within two weeks then a follow up

telephone call should be made to the patient, in order to establish eligibility using

the stage two procedures. A stage 2 interview can be conducted over the

telephone.



5.4          Elective Admissions

Where the patient is chargeable, WMUH should NOT initiate any treatment

process, e.g. by putting the patient on a waiting list, until a deposit equivalent to the

estimated full cost of treatment is obtained. If no deposit is obtained then WMUH

should NOT perform the procedure.

A patient from an EEA member state (Appendix 8) can be added to a waiting list in

the same way an NHS patient can be, however if the diagnosis is on the PBR Tariff

(Payment By Results) then this is transmitted to the Department of Health in the

same way as PBR. If the diagnosis is not on the PBR tariff then an IGA Form is

completed (Appendix 12) and sent to:

Leeds North East Primary Care Trust
Overseas Visitors Section (Finance)
Sycamore Lodge
7a Woodhouse Cliff
Leeds
LS6 2HF


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5.5         Tertiary Referrals

When a Consultant accepts a tertiary referral the patients status should be

established prior to admission unless the patient has a life threatening condition or

is in need of immediately necessary treatment. If this is not possible due to the

patients condition then the status should be deemed as soon as the patient is

stable (in the clinician‟s view) and informed that they are liable or not liable for any

further charges for NHS care.



5.6         18 Weeks

Chargeable patients are entitled to non emergency treatment if they are willing to

pay for it, therefore they can have a clock and be on the 18 week pathway, but it

can be stopped and suspended at any time by the Income Generation Manager.

Where a patient has received a referral from a GP and has had a clock started, but

subsequently it comes to light that they are not entitled to free treatment, then their

clock must be suspended until they have paid any monies owing to the Trust.

Chargeable patients access non emergency treatment at WMUH on a pay as you

go basis. If a chargeable patient pays any monies owing then their clock can be re-

started, this advice must come from the Income Generation Manager, proof must

be supplied by the Income Generation Manager that all outstanding accounts are

settled before treatment can recommence. This is regardless of where the patient

activity happens.



6.     Roles and Responsibilities of Trust Officers

6.1         Directors

The Leadership and direction of WMUH is shaped by the Directors of each

Directorate it is within their responsibility to implement the Overseas Patients Policy



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in line with current WMUH procedures, local rules and codes of practice. The policy

must be cascaded through the levels of General Management within WMUH.



6.2         Associate Directors

Each Associate Director (AD) is responsible for ensuring all of the relevant staff

within their service area is aware of the policy and what the implications are in

respect of not following it. The policy must be communicated to all staff within their

division irrespective if they have admitting rights or frontline patient contact.




7.      Procedure for all Interviews

7.1         Stage One Interview (BLQ Process Appendix 6)

Stage One officers are generally part of the Admin team of each service area, e.g.

OPD Clinic Clerks, A&E Reception, etc They have a duty to follow the Trust policy

on interviewing patients, using registered interpretation services where appropriate

and maintaining the privacy and dignity of the patient at all times. The interview is

effectively the baseline questions and the production of the evidence. This process

should not take longer than a few minutes.



The Baseline questions must be asked of every patient regardless of their colour,

language, surname, creed, etc otherwise the Trust can be accused of not treating

every patient in a fair and equal manner.



Once the BLQ process has been completed if the admin staff have any doubt

whatsoever about the answers given then they must refer them to the Income

Generation Manager for Overseas Patients for further investigation. It is not within

the remit of admin and clerical staff to establish eligibility.


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The majority of patients will not be liable for charges. The purpose in asking the

baseline questions at this stage is to avoid discrimination and to ensure that patient

who are liable fore charges are identified at the earliest opportunity.



7.2           Stage Two Interview

The Stage Two Officer (this does include the Income Generation Manager) but also

each service area has an appointed officer. The Income Generation Manager will

provide advice and leadership to the team of stage two officers. Ensuring that the

team are up to date with current legislation and are fully supported and trained in

order to carry out the interviews.

The process for the Stage Two Officer:

         Research all information with regard to the patient before the interview

          commences (use CaMIS, Symphony, GP Referral letter, NSTS)

         Always ask Nursing staff if the patient is well enough to be interviewed.

         Ensure that infection control procedures are adhered to without exception.

         Arrange an interpreter if required (this should be the Official Trust

          Interpreting Service).

         Always respect the patient‟s dignity and confidentiality – ensure that the

          interview is conducted in a private way as possible, if the patient is bed

          bound the curtains MUST be drawn. If the patient is mobile conduct the

          interview in a side office on the ward.

         It will become clear as the interview progresses if the patient is not ordinarily

          resident, but some patient may dispute this assessment. It is up to the

          patient to prove that they are exempt from charge, not up to the Trust to

          prove that are not. If the Stage Two Officer is not satisfied with any or all of

          the responses then the patient should be charged.



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         The patient can be reimbursed at a later date if they successfully prove they

          were entitled to exempt treatment at the time of the charge.



7.3           Upon deciding that the patient is liable for charges as an Overseas

              Visitor the Stage Two Officer must also carry out the following duties:

                  Ensure that the patient details are appropriately recorded.

                  Request the full cost of the treatment in advance (or in the case of

                   an in-patient before discharge) this will be taken by credit, debit card,

                   cheque, cash, and bankers‟ draft.

                  An initial deposit of £450.00 or one bed day whichever is greater

                   should be charged to the patient, which should cover one bed day

                   and any initial tests. (If the patient is in CCU or ITU then this charge

                   should increase to £750.00).

                  Request an immediate invoice be raised.

                  Provide advice on overseas patients issues, where appropriate or

                   liasing with the Income Generation Manager in more complex cases,

                   xxxxxxxxx, xxxxxxxx.

                  Assist in cases where repatriation is requested.



7.4           Patients found liable for charges

If the patient is liable for charges, explain the procedure to them and to the next of

kin, or an advocate acting on the patient‟s behalf. The liability to pay rests with the

patient, however an undertaking to pay can be taken from anyone the patient

nominates to act on his or her behalf. In some cases a guarantor may be

requested. The £350.00 initial deposit or 50% whatever is greater should be

requested here or an estimate for the full cost of treatment (Appendix 7), followed

by an invoice for the full cost of treatment. This should be handed to the patient and

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payment sought immediately, using a credit/debit card or any other acceptable

means. If the patient has left the hospital then this should be posted in the normal

way to the patient‟s home address and standard business terms used including

national and international debt recovery.



7.5         Personal Liability

The regulations state that a deposit for an estimate for the full cost of treatment

should be obtained from the patient prior to any treatment being given. The Trust

will require the patient to sign an undertaking to pay form and a credit card

agreement form; both of these forms produce a contract between the Trust and the

patient. However the patient is liable for charges irrespective of if they sign an

agreement or not.



7.6         Patients who are insured

Charges for patients who are insured are calculated on the same basis as the

patient who has personal liability. It is not best practice to, nor it is advised by the

department of health to deal with third parties, therefore any charge should be

made to the patient and it is up to them to make their own claim to the insurance

company. The Trust will not deal with overseas insurance companies unless in

exceptional circumstances and it has been cleared in advance by the insurance

company involved. The final decision is made by the Director of Finance.



7.7         Overseas Visitors Sticker

An overseas visitors sticker is added to the FRONT of the medical notes once a

patient is identified as being chargeable.




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                           OVERSEAS PATIENT
               Please contact:: Income Generation Manager
                          for Overseas Patients
                           xxxxxxxxx, xxxxxxxx

                LIABLE                      EEA                NOT LIABLE


7.8         Training and Development

Appropriate training is essential to enable staff to confidently undertake stage one

interviews (Baseline Questions). Associate Directors in each service area must

ensure that relevant staff have undertaken the minimum level of training in order to

complete the interview. It is best practice to assume that Associate Directors should

ensure that overseas visitors‟ training is part of each staff member‟s Personal

Development Plan (PDP).



7.9         Medical Staff Responsibilities – Stabilise & Discharge

There will be many times when medical treatment is required for an overseas visitor

who is liable for charges and is unable or unwilling to pay for the cost. (there is no

distinction made between unable and unwilling to pay in the Regulations). In such

circumstances WMUH will provide only immediately necessary treatment to the

patient, in order to save their life. Once the patient becomes stable and out of

immediate danger then the Stabilise & Discharge protocol must be followed.

Immediate Necessary Treatment is treatment required to save the patients life, not

what is clinically appropriate for the treatment of a certain condition. It is important

that the Trust minimises the financial loss by ensuring that this is facilitated as soon

as the patient is decided by three Clinicians to be stable. All decisions must be

recorded in the patients clinical notes. If the patient states that they have no funds

then the Medical Practitioner is asked to complete an „advice from doctor‟ form (see

Appendix 10)



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As agreed by the Medical Staff Committee if a patient is to be discharged in a

stable condition then this stable condition is determined by the treating consultant

and two other consultants. If they concur with each other then the patient will be

discharged from the Trust‟s care. The patient is able if they so wish to re-enter the

Trust via the Accident & Emergency Department and be re-assessed in the normal

way. The Regulations make no provision for how many times a patient can attend

A&E but they do advise Trusts that it is in the best interests of the patient for them

not to receive a large bill for the cost of their care as an inpatient.

To minimise the potential financial loss of a non-paying patient and to take

advantage of the short stay threshold on the APC National Tariff, it is advisable that

the whole process should not take longer than 48 hours. This enables the Trust to

write off only 20% of the value of applicable HRG codes.



7.10        Complaints

Where a patient is unhappy with the care they have received it is vital that they, or

someone acting on their behalf (with their consent) should take appropriate action

with regard to the Trust‟s complaints procedure.

All Stage Two interviewers must be aware of the Trusts Complaints Policy, of the

Advocates Policy and the PALS service.



7.11        Deceased Patients

Where a patient dies without making or completing a payment to the Trust no other

person becomes liable for the debt. However the debt can be recovered from the

person‟s estate. Any decision made by the executor of the estate is final (this must

be checked with legal.) An offer from relatives or another person to meet the debt

can be accepted but this must not be actively pursued, unless it was they who had

signed the undertaking to pay form.

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7.12        Financial Matters

If the Trust is satisfied that the patient is an overseas visitor then WMUH must levy

charges against the patient. If there are any doubts over the validity of exemption

for a patient then this patient should also be charged for their treatment. Invoices

should be produced in all cases and given to the patient.

If the patient refuses to pay or states that they have no funds available to pay (this

is treated as a refusal to pay) then a payment plan can be negotiated in order to

settle the debt. This is at the discretion of WMUH and the Trust at any time can

request the full and immediate settlement of the outstanding balance. This will be

used in cases where the patient has defaulted on payments.



The Trust is not allowed to waive any of the charges to Overseas Patients, nor has

the Chief Executive of the Trust the authority to waive any of the charges. The

Senior Medical staff of the Trust have no authority to waive any charges,

furthermore they have no authority to assess if a patient is exempt from charges,

this is the responsibility of the Stage Two Officers and the Income Generation

Manager for Overseas Patients.



7.13        Pharmacy

Overseas Visitors are not entitled to receive an NHS subsidised prescription, this is

open to those who benefit from the NHS not those who are not entitled to receive

benefits for free. Therefore they must pay what is appropriate to the Trust, which

currently is the charge of a private prescription (details from Pharmacy & PP Tarrif).



7.14        Timely Decision and Action




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The longer the elapsed time between the treatment or discharge and payment, the

less likely any outstanding amount will be collected. Therefore it is imperative that

all stages of the process treat Overseas Visitors payments with the utmost urgency.

e.g. immediate invoicing should be available, including itemisation if requested by

the patient or the Income Generation Manager. However, a breakdown of what

consists of in a HRG (Healthcare Resource Group – PBR National Tariff) is not

possible. If there is any delay the ultimately the Trust will bear any associated

costs, this risk has to be minimised by efficient systems.



7.15        Writing Off Bad Debt

It is not acceptable not to bother raising an invoice for treatment provided to a

chargeable overseas visitor because it is believed or claimed that they are unable

to pay. It is unfortunate that some overseas patients when challenged claim they

have no funds but it is not the concern of the Trust how they will pay, just that they

will pay. All efforts must be made to pursue overseas debt. Overseas patients who

cooperate with the Trust will be considered for payment plans if they are unable to

pay for the full amount in one go provided they pay 50% deposit up front, the

balance to be paid over a determined amount of time as indicated by the Trust.

This is in accordance with best practice in many industries where large purchases

are involved. Patients who have made a conscious decision to seek treatment at

West Middlesex Hospital in an attempt to obtain treatment by deception will not be

considered by a payment plan.



7.16        Reasons for this approach:

      Unidentified Overseas Patients (UOP) incur additional expenditure, which

       cannot be funded from elsewhere.

      The patient receives sufficient treatment to allow them a safe return home.

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   Overseas patients do not use beds in NHS hospitals at the expense of NHS

    patients.

   The overseas patient is not placed in a position where the bill for their

    treatment is increased beyond what they can realistically pay for. And as

    such WMUH does not fund for free patients who cannot or will not pay. The

    management of public money is the paramount reason for this approach.

   The NHS is free at the point of delivery and chargeable at the point of entry

    for those who are not eligible.




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  Appendix 1 – Overseas Patient Record Form

 Name of Patient                                                                              Hospital Number

     Date of Birth                                                                            WARD/AREA

     UK Address:




   Home Address




  Diagnosis/HRG:

Admission /                                  Discharge Date:
Activity Date:
  PART B - Person Undertaking to pay on the patient‟s behalf
          Name:

                 UK Address:



            Home Address



   Relationship to patient

  PART C – Declaration
  I undertake to pay West Middlesex University Hospital for the full cost of my treatment, this will be
  calculated and given to me as a quote for care. I understand that this charge will increase as treatment
  continues and I shall pay the initial quote as soon as possible and the final account upon discharge. This
  is in accordance with Regulations currently in force under section 121 of the NHS Act 1977 in respect of
  NHS treatment.
  It is a criminal offence to provide incorrect and misleading information on this form. I understand obtaining
  treatment by deception is fraud and will not be tolerated by West Middlesex University Hospital NHS Trust
  and, as such cases will be referred to the Local Counter Fraud Specialist and may be referred to the police
  for further action. Furthermore, I understand that if I leave the country West Middlesex University Hospital
  will take reasonable steps to recover the debt using an international debt collection agency and I will be
  liable for this cost also.
  Signed…………………………………………………..……………………..Date…………………………………

  Print Name….:…………………………..……………..…………….Passport Number:…………………………

  FOR FINANCE USE ONLY
  Paid in Full                            Paid in part:                             Payment Method:


  Insurance – Invoice                     Balance payable:                          Receipt Number /Authorisation
                                                                                    Code

  Requested by:                                                                     Date of Receipt:


  Designation:


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Appendix 2 – Stage 2 Interview Record

I have attended a Stage 2 interview with ………………………………….. at West

Middlesex University Hospital. It has been found that I am/am not liable for the charges

for NHS treatment as an Overseas Visitor (Implementing Overseas Visitors Charging

Regulations April 2004).

Referred by                  Under the Care of              Bleep        Comments



Diagnosis




Affix patient label here:




                    LIABLE                                                   NOT LIABLE
I am liable/not-liable for treatment as an NHS CHARGED PATIENT (overseas visitor)
and I am unwilling/willing to pay for the cost of the treatment.
I understand that West Middlesex Hospital is unable to offer this treatment without
making a charge. I understand that if I go to another NHS Trust then I will be liable for
the cost of treatment with them too. I consent for my details to be passed on to other
NHS Trust‟s in order to safeguard NHS resources.

I am aware that it is my choice to decline the treatment today and if I require treatment I
will make other arrangements.

Patient Name                           Patient Signature                        Date




Overseas Patients Manager              Signature                                Date




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 Appendix 3 – Card Declaration

 I have signed a declaration to pay West Middlesex University Hospital NHS Trust for
 the cost of NHS treatment for the patient named underneath.


 I understand that I will pay all charges attributed to this episode of care and it will be
 taken from my credit/debit card.


 The amount owed will increase as the length of stay increases and further tests are
 carried out.


 I have received a quote for care and I accept the charges listed on this as a fair and
 accurate estimation of the cost.


 I authorise West Middlesex Hospital to charge my credit/debit card (in my absence) for
 the full cost of treatment.
 Patients name:                                                           Ward/Area:


 Hospital Number:                                                         Consultant:

 My details are as follows:

Name on Card

    Card Issuer

      Start Date                                                              Expiry Date

       Signature

                             (Long number through the centre of the card)
 Card Number

          Amount £

                             (Last three digits on the signature strip)
Security Code

   Signed on behalf of West Middlesex

                                          Designation

                                                     Date

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Appendix 4 – Medical Holiday Insurance Declaration

Does the Patient have holiday/medical insurance:                                              yes            no


Patient:                                           Hospital Number:

Insurance details:

Name of
Company:


Address of
Company:




Policy Number:


Contact Name at
Company:

Level of cover




I am aware that it is a criminal offence to give incorrect or misleading information on
this form. I understand that obtaining treatment by deception is fraud and will not be
tolerated by West Middlesex University Hospital NHS Trust.

I understand that I shall pay West Middlesex University Hospital NHS Trust for the cost
of my treatment as an overseas visitor and that I will claim any charge back from my
insurance company.

I understand that it is policy of West Middlesex University Hospital NHS Trust not to
deal with overseas insurance companies, except in exceptional circumstances, which
is at the discretion of the Director of Finance. Any decision is final and non negotiable.

Patients Name:                                           Date:


Signature



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  Appendix 5 – A to Z of Overseas Patients: But what about………?

Abortion                 See Termination of Pregnancy (ToP)

AIDS                     See HIV

Ambulance                The Regulations do not apply to ambulance services. These should
Services                 be provided free of charge where they are part of the patients
                         clinical need.

Artificial Limbs         See Prosthetic services

Asylum Seeker            A person who has made a formal application to the Home Office for
                         recognition as a Refugee under the 1951 UN Convention and its
                         1967 Protocol Relating to the Status of Refugees.
                             A person who has made a formal application for asylum in
                                the UK will be issued with an Immigration & Nationality
                                Directorate (IND) Application Registration Card (ARC). This
                                card contains a photograph of the asylum seeker, details
                                such as their name and an electronic chip containing
                                biometric information.
                             Where an asylum seeker has had an initial application for
                                refuge refused he or she has rights of appeal. They will
                                continue to be entitled to hospital treatment without charge
                                until the asylum appeal has been exhausted.
                             If an asylum seeker‟s claim is finally rejected (including
                                appeals) they cannot be charged for a course of treatment
                                they were receiving at the time their status was determined.
                                That remains free of charge until completed. The must
                                however, be charged for a new course of treatment. If that is
                                routine elective treatment then payment should be handled
                                in the same way as everyone else seeking non-urgent
                                treatment, i.e. payment should be obtained before treatment
                                begins.

Au Pairs                 Au Pairs are not employed as such and therefore are not
                         automatically eligible for free treatment. Au Pair is a technical term
                         applied by the Home Office when granting entry to the UK, usually
                         for a minimum of two years, and it can apply only to people from
                         certain countries. Many of these countries have bilateral healthcare
                         agreements with the UK or are EEA member states or Switzerland,
                         so the au pair would be eligible for any treatment, which arises
                         during the visit.
                         Alternatively the Au Pair coming to the UK can be settled and living
                         for a period of time may be considered „ordinarily resident‟.
                         The Trust must decide on each individual case and it be judged on
                         its own merits.




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Authorised Child        A child of a person who has been given leave to enter the UK with
                        a parent who has come to the UK for specified treatment under
                        provision of Regulation 6A; or a child of an authorised companion
                        of such person given leave to enter the UK. There may be several
                        authorised children travelling with the exempt person or their
                        authorised companion. An authorised child is eligible for free
                        treatment the need of which arises whilst they are here.

Authorised              A person who has been given leave to enter the UK with a parent
Companion               who has come to the UK for specified treatment under the provision
                        of Regulation 6A. There will normally only be one authorised
                        companion, and they will be eligible for free treatment which arises
                        during their stay here.

BaseLine                All Trusts should have systems in place to ask all patients
Questions (BLQ)         beginning a new course of treatment at the Hospital the BaseLine
                        Questions. (There is a page in every set of notes that asks these
                        questions and a copy of the flowchart for distribution is contained in
                        Appendix 6).
                        Where a person‟s answers to the BaseLine Questions indicate they
                        may be chargeable, they must be referred for a second interview
                        with a trained member of staff to establish eligibility. (Directorate
                        Income Generation Manager or Other Stage Two Officer.)

Community               Some services delivered in the community will be subject to charge
Services                as services delivered by WMUH on behalf of the community. Where
                        staff not supplied by WMUH supplies services then the charging
                        regulations do not apply.

Confidentiality         WMUH staff becoming aware that a patient may be here without
                        the proper authorisation must make a decision in the full light of the
                        patient‟s circumstances as to the reporting of their immigration
                        status. It is important each case is judged on its own merits. There
                        is a public interest argument in the reporting of such patients but
                        this should be weighed with the medical confidentiality rules and
                        the medical needs of the patient. It must be discussed with WMUH
                        Caldicott Guardian. (Janet Baldwin – Medical Director). With a
                        possible view to discuss with WMUH legal advisors also.

Dependant               Where are child who normally lives abroad is visiting a parent who
children visiting       is ordinarily resident in the UK, that child can take on the status of
an       ordinarily     the parent if they have dual access or joint custody.
resident parent
Dependants              For all patients, except those from EEA member states,
                        dependants are limited to marriage partner and children under the
                        age of 16, or under 19 if still in fulltime education or receiving child
                        benefit. For EEA member States the accepted dependants of a
                        person will be named on the relevant E form issued or other identity
                        documents.

Dialysis                The Regulations, and therefore the charges, apply where visitors to
                        the UK require haemodialysis or peritoneal dialysis for the
                        treatment of kidney failure.
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                                 Temporary visitors from the EEA countries and Switzerland
                                  (other than for medical purposes) i.e. on holiday or on
                                  business, or for short-term work, do not need an E112 to
                                  obtain dialysis treatment. This should be provided under the
                                  bilateral healthcare arrangements for immediately
                                  necessary treatment. This is subject to the patient making
                                  an advance booking and facilities being available at the time
                                  of treatment.
                                 For non-EEA countries with which the UK holds bilateral
                                  healthcare agreements with, only Australia has made
                                  provision for dialysis treatment to be provided as
                                  immediately necessary treatment.
                                 For Visitors from countries outside the EEA, Australia and
                                  Switzerland (including Channel Islands) the provision of
                                  dialysis treatment is not the responsibility of the NHS and
                                  patients are liable for charges.
                                 UK residents who enquire about the provision of dialysis
                                  whilst abroad should be directed to the NHS unit where they
                                  normally dialyse for advice. For EEA countries an E111
                                  (European Health Insurance Card - EHIC post Dec 2005)
                                  which will cover the cost of their treatment. In Spain it is a
                                  P10 form issued before their visit.)

Domiciliary             See Community Services
Nursing
Dual Residence          A person with homes in more than one country may be considered
                        ordinarily resident in the UK if the are likely to spend at least 9
                        months of the year living in the UK. However, if they are a person in
                        receipt of a British State Pension who spends not more than 6
                        months living in another EEA member state and not less than six
                        months living in the UK then they will be exempt under Regulation
                        4A even though they spend more than 3 months in another EEA
                        member state.

Employment              The Regulations do not define employment other than to make
                        clear self-employment is included, and that it must be with an
                        employer based in the UK or at a registered UK branch of an
                        overseas employer.
                        Self-employed workers must show that their principle place of
                        business is the UK.
                        Generally where there is any doubt that a person is employed it can
                        be satisfied by asking to see (up to date) documentary evidence
                        from the employer, or in the case of a self-employed person, a
                        letter from a reputable bank or solicitor.
                        Part time work will also count but WMUH must satisfy the reason
                        for being in the UK is primarily to work. Where are a person has
                        entered the UK as a visitor and has applied to switch to employed
                        status then this will not count.

Establishing            Full Guidance can be found at
Responsible             http://www.dh.gov.uk/assetRoot/04/06/97/97/04069797.pdf
Commissioner


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General                    The Hospital Charging Regulations do not apply to General
Practitioners              Practice. GP’s are able to offer treatment to overseas visitors on a
                           private basis but can also accept them as NHS patients, i.e.
                           exempt this is in accordance with the Human Rights Act 1998.
                           Such patients may receive an NHS card and number. This does
                           NOT automatically entitle them to treatment without charge at
                           WMUH, nor does the fact that they may be have been referred to
                           WMUH by a GP.
                           WMUH remains responsible for checking that all patients –
                           including those with NHS cards or numbers – are ordinarily resident
                           in the UK or otherwise exempt before treating them without charge,
                           unless care is required before liability status can be established,
                           e.g. major medical emergency..

Health Visitors            See Community Services

HIV                        There is no charge for a diagnostic test and any associated
                           counselling to establish if a patient is HIV positive. Any further
                           treatment needed, including the full cost of drugs, for HIV or AIDS
                           is liable to charges. If a liable patient is in possession of a HC2
                           certificate this does not exempt them from charges for drugs for
                           HIV/AIDS treatment.

Hospital at Home           See Community Services

Illegal Immigrants         It may happen that during investigations to establish a patient‟s
                           residence it transpires that the person is in the UK without proper
                           permission. This may be that they entered the country on a visitor‟s
                           visa that has since expired or they may have an application for
                           asylum rejected but have not yet been removed from the country. In
                           these cases charges may apply depending on the circumstances,
                           particularly if they have been in the UK for more than 12 months.
                           (See confidentiality)
                           If the Trust can prove that another government department has
                           failed in their statutory duty to remove persons from this country
                           WMUH will not accept the financial responsibility for these
                           person(s) and will move to transfer the outstanding balance to the
                           relevant department that has failed WMUH.

Immediately                WMUH needs to treat patients in need of immediately necessary
Necessary                  care regardless of their ability to pay. This may be because their
Treatment                  condition is life threatening, or because if treatment is not given
                           immediately it will become life threatening, or because permanent
                           serious damage will be caused by any delay.
                           It is a matter of clinical judgement that should not be second-
                           guessed by administrative staff.
                           However, in the interest of good audit management, the
                           responsible health professional‟s reasons should be recorded in the
                           patient‟s clinical notes and the request for advice from a doctor
                           (Appendix 10) should be completed.
                           Where immediately necessary treatment occurs and WMUH
                           knows that payment is unlikely, treatment should be limited to
                           that which is clinically necessary to enable the patient to
                           return to his or her own country.
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                         This should not normally include routine treatment unless it is
                         necessary to prevent a life-threatening situation. Any charge
                         payable for such treatment will still stand, but if it proves to be
                         irrecoverable, then it should be written off.

Israel                   There is no general bilateral healthcare agreement with Israel but a
                         person entitled to industrial injuries benefit in Israel is fully exempt
                         from NHS charges for treatment arising from their industrial injury
                         or occupational illness.

Maternity                Maternity services are not exempt from charges. However because
Services                 of the severe health risks associated with such conditions such as
                         eclampsia and pre-eclampsia, maternity services should not be
                         withheld if the woman is unable to pay in advance. The patient
                         remains liable for charges and the debt should be pursued in the
                         normal way.
                         Women from EEA countries and Switzerland are covered for all
                         maternity care i.e. antenatal and postnatal care for up to 15 weeks
                         after the birth of the child.
                         Women from non-EEA countries with which we have bilateral
                         healthcare agreements are eligible to receive immediately
                         necessary treatment in connection with their pregnancy, if an
                         unexpected emergency arises during their visit. This applies
                         irrespective of whether the pregnancy was confirmed in the UK or
                         elsewhere.
                         However if they come to the UK or remain in the UK to obtain
                         routine antenatal care or deliver their baby then charges will apply,
                         unless they are specifically referred to the UK under agreement
                         because of complications.

Midwifery                See Community Services

Newborns                 Where a baby is born in hospital mother and child are charged as a
                         single patient. If one of them is transferred to another department,
                         e.g. SCBU, the charge will continue to accumulate to recover the
                         full costs of treating them both.
                         If one is discharged and the other remains the charge will continue
                         to accumulate to recover the cost of treating the one remaining. If
                         either is transferred to a different hospital then that hospital will be
                         responsible for recovering the costs for the treatment that they
                         provide.

NHS    Card       or Having an NHS card or number does not give automatic entitlement
Number               to free NHS hospital treatment. Every patient’s eligibility should be
                     checked.

NHS      Charged Overseas Visitors who are liable for charges are NHS charged
Patients         patients. They should not be confused with private patients. They
                 must receive the same priority as NHS patients.
                 Unlike private patients NHS charged patients are liable to pay
                 for their treatment even where an undertaking to pay has not
                 been obtained.

No Recourse to A stamp on some visitor‟s passports. It does not apply to NHS
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Public Funds              treatment but prevents people from accessing UK social security
                          funds.

Non-urgent                Routine elective treatment that could in fact wait until the patient
treatment                 returned home.
                          The patient‟s chargeable status should be established as soon as
                          possible after the 1st referral to WMUH. Where the patient is
                          chargeable WMUH will not initiate treatment processes, including
                          assigning a waiting list entry, until a deposit equivalent to the
                          estimated full cost of treatment (Quote for care Appendix 7).
                          Any surplus, which is paid, can be returned to the patient on
                          completion of treatment. This is not refusing to provide treatment, it
                          is requiring payment conditions to be met in accordance with the
                          charging regulations before treatment can commence.

Norwegian                 A Norwegian national employed on a Norwegian registered vessel
Seafarers                 is exempt if brought to the UK for treatment on or from that vessel.

Observation               Patients kept in the Observation Wards attached to A&E at WMUH
Wards                     should not be charged unless they are formally admitted to the
                          hospital as an inpatient.

Offshore Workers          A person working in UK territorial waters or in the UK sector of the
                          Continental Shelf is exempt, as is an offshore worker working
                          elsewhere on the shelf if his employer or contractor has his
                          principal place of business in the UK.

One Year Rule             There is no „one year rule‟ that‟s says you have to be in the UK to
                          receive free treatment at WMUH. This should not be confused with
                          the exemption for people who have been living lawfully in the UK
                          for 12 months immediately preceding the date at which treatment Is
                          given. Someone who is ordinarily resident, or is exempt under one
                          of the other exemptions is entitles to free treatment from the day
                          they arrive in the UK, there is no qualifying residence period.
                          In order to take the House of Lords judgement into account, when
                          assessing the residence status of a person seeking free NHS
                          services, WMUH must consider:
                                  “….living lawfully in the UK voluntarily and for settled
                                  purposes as part of the regular order of their life for the
                                  time being whether they have an identifiable purpose
                                  for their residence here and whether that purpose has
                                  sufficient degree of continuity to be properly described
                                  as „settled‟.”

Overseas Visitor          Any person of any nationality who is not ordinarily resident in the
                          UK.

Permanent                 People taking up permanent residence in the UK are entitled to free
Residence                 hospital treatment. They must however have the legal right to live
                          here permanently and WMUH can ask to see evidence of that right
                          before exemption can be granted.
                          People who have a right to live here and claim to be returning here
                          permanently to the UK after living abroad can be asked to provide
                          evidence to support such a move – perhaps the sale of such
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                          property abroad, shipping of belongings, transfer of assets, etc

                          People who have made applications for permanent residence will
                          be chargeable up until they are granted leave to remain by the
                          Home Office or they have completed 12 months lawful residence
                          and then charges will cease.
                          Where are person applies to extend their current entry visa, only
                          those claims that are made before the existing visa runs out will be
                          considered as lawful residence.
                          Where a person applies to extend their leave to remain after their
                          current visa has expired the calculation of 12 months lawful
                          residence starts from the date they reapplied.

Prisoner                  Anyone who has to be detained under provision of section 43(1) of
                          the Prison Act 1952 or anyone who has been detained under
                          provision of the Immigration Act 1971.

Prosthetic                The artificial Limb and Appliance services are not provided under
Services                  the NHS Act 1977, and the overseas visitors charges Regulations
                          made under that Act cannot therefore apply to services provided by
                          them.
                          Patients who are liable for charges under the Regulations and who
                          needs artificial limbs or appliance must therefore obtain them
                          privately.

Public purse              A term used in some travel documents to signify the holder cannot
                          access UK social security benefits. It does not apply to NHS
                          treatment.

Refugee                   A person who has been granted asylum by the UK government has
                          been recognised as a refugee (a successful asylum seeker) and is
                          exempt from charges.

Repatriation back When a person goes to live outside of the UK the NHS ceases to
to the UK         have responsibility for their healthcare. If such a person is taken
                  seriously ill the NHS is not responsible for funding their repatriation
                  back to the UK.
                  However if a patient‟s family make their own arrangements to
                  repatriate the patient who on arrival will be resuming their
                  permanent residence, then they will become entitled to access full
                  NHS treatment from the date of their arrival.
                  If WMUH is advised in advance of the patient‟s arrival the we must
                  make adequate arrangements to ensure that the patient receives
                  the appropriate healthcare upon their arrival back in the UK.

Repatriation back Where a person has received NHS treatment and has not been
to the Visitors able to pay for that treatment and expresses a wish to return home,
home country      WMUH can consider funding the cost of the repatriation if the cost
                  of the repatriation outweighs the cost of treating the patient and will
                  therefore produce a cost saving for the Trust and if the patient gives
                  consent to return home.
                  It is not possible to force repatriation of a patient.

Routine                   This includes routine monitoring of conditions like diabetes. Such
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Monitoring              provision will not be covered under existing non-EEA bilateral
                        healthcare agreements and charges will apply.

Seamen or women A person working on a UK registered ship is exempt from charges.
                A person who is working on any other registered vessel is exempt if
                they are ordinarily resident in the UK.
                If they are from an EEA country or Switzerland, a non-EEA bilateral
                healthcare country and the need for treatment arose in the UK or
                on a voyage to the UK; or if they are a former UK resident and the
                five or ten year exemptions apply.

Six month Rule          There is no six-month rule that says you have to have been in the
                        UK for six months before you are entitled to free NHS treatment.

Sponsors                Some people are allowed into the UK only because another person
                        or authority has agreed to sponsor their stay here and guaranteed
                        that they will not become a drain on the public purse. The public
                        purse does not include NHS treatment, therefore sponsored people
                        can use the NHS and must be exempt in their own right.
                        A sponsor is not liable for NHS charges and charges must be
                        sought in the same way as an overseas visitor if the person
                        requires NHS treatment. Even if the sponsor has offered to pay.

Spouse        (and Where a person is exempt from charges for NHS hospital treatment
children)          then so is their marriage partner (but not an unmarried co-habitee
                   or „common-law‟ partner) and children when they are either:
                        In the UK with the exempt person for the duration of their
                           visit; or
                        Living permanently with the exempt person if they have
                           come to the UK on a settled basis
                   The exempt person must be in the UK with their spouse and/or
                   children.
                   Where a person is ordinarily resident and their spouse lives abroad,
                   the spouse will not be considered ordinarily resident on a visit to the
                   UK. Unless they meet one of the exemptions from charge in their
                   own right then they are liable for charges.

State Pensions          The following are UK state pensions to which there is entitlement
                        under the Social Security Act 1975 and which could apply to a
                        person living overseas:
                             Retirement pension
                             Attendance allowance
                             Widow‟s benefit
                             Industrial injuries disablement benefit
                             Incapacity benefit
                             Severe disablement allowance
                             Guardian‟s allowance
                             Disabled living allowance
                             Carers allowance
                        Occupational pensions (including civil service pensions) are not
                        state pensions.

Students                People who are pursuing a full time course of study of not less than
                        6 months in duration or people who are pursuing a full time course
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                        of study of any duration which is funded either wholly or
                        substantially by the UK government. A person here on a visitor‟s
                        visa spending a few hours a week learning English is a visitor not
                        a student and therefore liable for charges.

Termination    of Where a patient seeks a ToP and is liable for charges but is unable
Pregnancy (ToP)   to pay in advance the hospital may decline to provide the service
                  and should advise the woman to seek termination in her own
                  country.
                  The only exception to this is where the woman's life is at risk. In
                  these circumstances the termination should take place. The patient
                  remains liable for charges and debt should be pursued in the
                  normal way.
                  Women from a bilateral agreement country who come to the UK
                  specifically to seek ToPs will be liable for charges unless they
                  have either, (for EEA nationals, obtained an authorised E112 form
                  from their own health institutions,) or for Non-EEA bilateral
                  agreement countries, have been specifically referred for treatment
                  under the terms of the agreement.


Treatment    the        The limiting of access to treatment without charge to conditions,
need for which          which occur, only whilst present in the UK or in the Doctors opinion,
arose during the        although pre-existing, need immediate treatment to prevent
visit                   deterioration.

Twelve     Month See one year rule
Rule
UK Government People claiming exemption under this Regulation should be able to
Financed Posts   provide satisfactory documentary evidence of their entitlement.
                 Recruitment must have taken place in the UK and will include
                 people working for the Department for International Development
                 and the British Volunteer Programme.

UK Government People who are pursuing a full time course of study, of any
Financed students duration, which is funded either wholly or substantially by the UK
                  Government. The must provide satisfactory evidence of their
                  entitlement.

Unaccompanied           Children of overseas visitors will rarely be exempt in their own right,
Minors                  but only via their parent‟s status. Thus where treatment is given to a
                        child under the age of 16 who is in the UK without his or her
                        parents it will be chargeable unless the treatment itself is exempt
                        (e.g. provided solely in the A&E department or the Observation
                        Suite. The liability should be explained to the person in whose
                        charge the child has been left (e.g. teacher, tour leader, host) and
                        the bill handed to that person. Copies should be sent to the child‟s
                        parents.
                        A further exception is that children from EEA member states or
                        Switzerland who will be eligible for free treatment the need for
                        which arose during their visit (E111 or EHIC arrangements) as will
                        children from bilateral agreement countries.
                        A further exception is unaccompanied minors attending boarding
                        school in the UK whose parents both live outside the UK. In this
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                        case the child will be classed ordinarily resident while at school
                        because in legal terms the school act in loco parentis.

Unemployed              There is no exemption for unemployed persons with the exception
persons                 of people here under specific EEA arrangements. This person will
                        have a copy of form E119, without this form they are liable for
                        charge.

Urgent treatment        Where the treatment is, in a clinical opinion, not immediately
                        necessary, cannot wait until the patient returns home. Patients
                        should be booked in for treatment, but the Trust should use the
                        intervening period to establish the patients‟ chargeable status.
                        Wherever possible, if the patient is chargeable, WMUH should seek
                        a deposit for an estimate of the full cost of care. Any surplus could
                        be returned to the patient upon completion of treatment.

Volunteers              Exemption from charges is limited to those people who are
coming to the UK        providing services that are similar to health or social services.

Volunteers       from People who leave the UK to spend time as a volunteer are not
the UK                automatically entitled to return to the UK for free hospital treatment.
                      Each case should be carefully considered. Only people working on
                      a UK government financed project are automatically entitled.
                      Others may be if they are returning to take up permanent residence
                      and they can be exempted under ordinarily residence criteria.

Waiving charges         No power has been given, in the Regulations or otherwise, for any
                        person, including the Trust Chief Executive, the lead Consultant or
                        a Government minister, to waive charge which are due.

War pensions            The holder of a UK war disablement pension is fully exempt from
                        charges not just those relating to his or her injury. His or her spouse
                        and children are also fully exempt. The holder of a UK war widow‟s
                        pension is also exempt.

Write-off debt          Where debt is unrecoverable WMUH can write it off. However, the
                        Trust must take all reasonable measures to recover the debt,
                        including consideration of using a debt collection agency if it‟s
                        financially viable.
                        Overseas debt must be written off correctly.




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Appendix 6 – The BLQ Process (The Base Line Questions)




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Appendix 7 – Quote for Care


Quote for Care:

Prepared on ……………………. by (or put Name, designation, contact details here)
Andy Finlay - Income Generation Manager – xxxxxxxxxxxxx, xxxxxxxxxxxxx, xxxxxxxxx

Patient Name

Date of Birth                                             Postcode

Home Address:




Ward/Area:                                                Admission Date:

                                                          Discharge Date:

INPATIENT STAY                                                TO
COST:                                     £                   TRANSFERRED TO:
INPATIENT STAY
COST:                                     £
DRUGS                                     £

MINIMUM REQUIRED                                              £

The above quote is based upon projections of care; if there are any complications with
the patient or after delivery, your child requires further treatment, I understand that will
be an additional charge.

I shall pay West Middlesex University Hospital NHS Trust for the full amount of the cost
of care using the most appropriate method to the Trust (credit/debit card, cash, cheque
+ guarantee card to the limit, bankers draft).

I understand that if I leave the UK without paying, that West Middlesex University
Hospital NHS Trust shall make reasonable efforts to recover the debt using an
International debt collection agency.

Any non-payment of the debt may have further implications on any future entry
requirements into the UK.

I have read the quote and the statement and I understand and agree the terms quoted.

Signed (patient)                                          Date:


Signed (on behalf of WMUH)                                Date:



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Appendix 8 – EEA & Non-EEA Bilateral Healthcare Agreement Countries and
Territories

Anguilla                                                    Kazakhstan *
Armenia *                                                   Kirgizstan *
Australia                                                   Macedonia *
Azerbaijan *                                                Malta *
Barbados                                                    Moldova *
Belarus *                                                   Montserrat
Bosnia *                                                    New Zealand *
British Virgin Islands                                      Poland
Bulgaria                                                    Romania
Channel Islands                                             Russia *
Croatia *                                                   Slovak Republic *
Czech Republic *                                            Slovenia *
Falkland Islands                                            St Helena
Georgia *                                                   Tajikistan *
Gibraltar *                                                 Turkmenistan *
Hungary *                                                   Turks and Caicos Islands
Iceland                                                     Ukraine *
Isle of Man                                                 Uzbekistan *
Yugoslavia, * i.e. Serbia & Montenegro

Countries with an (*) asterisk have agreements covering their nationals and UK
nationals only. The others cover all residents, irrespective of nationality. It is for non-
nationals residents in an “all residents” country to produce evidence of their residential
status. N.B. The Czech Republic, Hungary, Malta, Poland and Slovenia joined the EU
on 1st May 2004 and Bulgaria & Romania join the EU on 1st Jan 2007 and the bilateral
healthcare arrangements are replaced by EC regulations. Iceland is an EEA member
state but the bilateral healthcare arrangements also cover non-EEA nationals resident
in Iceland. The agreements covering nationals only applies to nationals living in their
own country, not if they are living in another country with which the UK holds a bilateral
healthcare agreement.


Persons who can present a passport, residence permit, identity card or social security
card showing that they are either nationals or residents as appropriate of any of these


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countries should be treated as exempt from charges in respect of treatment the need
for which arose during a temporary visit to the UK.




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Appendix 9 - Out of Hours Form


Overseas Patients Record Form (Out of Hours only)
Form Completed by


Job Title


Bleep Number


Signed


Do not leave the above area blank – an audit trail needs to be established for each patient.

Patient Name


Date of Birth                                                Postcode


Home Address:




UK Address:




Ward/Area:                                                   Admission Date:


Credit Card details recorded                                  YES/NO
Reason for NO:



Please do not use this form if it is Monday to Friday xxxxxxxxxx. (Unless you have
been notified the IGM is not on site.


Please xxxxxxxxx or dial xxxxxxxxx for the Income Generation Manager.




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Appendix 10 – Advice for Doctor & Medical Practitioners

Dear Doctor


NAME OF PATIENT


Date of Birth:                                     Hospital Number:




This patient is an overseas visitor as defined in the National Health Services (Charges
to Overseas Visitors) Regulations 1989 as amended. Having interviewed the patient we
have found him/her to be liable for charges as an overseas visitor.

Government advice to safeguard NHS resources is to obtain payment where possible
before treatment is given. In this case the patient also declared that he/she will not be
able to pay for the treatment to be provided prior to receipt of the treatment. Would you
therefore tick one of the declarations below?



           I intend to give treatment, which is immediately necessary to save the
        patient‟s life.



          I intend to give urgent treatment, which is not immediately necessary to
        save the patient‟s life, but cannot wait until the patient‟s returns home.



          No treatment will be given unless payment can be made.


Where treatment is given (or has been given already), the Trust is obliged to raise an
invoice for the cost of any such treatment, and to pursue debt recovery procedures if
necessary.


Date:                                                 Signed:                                       (Doctor)



Print Name:


Date:                                                 Signed:                  (Overseas Visitors Manager)




                                                                                              Overseas Visitors Policy
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Print Name:



Appendix 11 – Standard Enquiry Letter to Patient


Name of Patient
Address 1
Address 2
Address 3


Hospital Number:
Date:


Dear
You have been referred to this department to validate your claim for free NHS
treatment.


It is your responsibility to prove to West Middlesex University Hospital NHS Trust your
claim for exemption from charge. If you do not provide satisfactory evidence of your
claim you will be deemed liable for charges and we will issue an invoice for any
treatment given and seek a deposit for the full cost of any future treatment.


In order to determine your eligibility for free treatment it is necessary to verify your
residential status. We will require you to produce any relevant residency papers, a
work permit and entry visa to the UK.


Please make sure you contact us before you attend any further hospital appointments.
We will be happy to make an appointment to process your claim at your earliest
convenience. Please telephone xxxxxxxxxxxxx direct line or xxxxxxxxxxxxx, xxxxxxxxx
to arrange this.


We must stress that we cannot guarantee non-emergency NHS treatment to you until
we have processed your claim for exemption.


Yours sincerely


Overseas Visitors Office
                                                                                               Overseas Visitors Policy
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               Appendix 12 – IGA Form
IGA (Previously IGA 19)                                                                                                             DEPARTMENT OF HEALTH
                                                                                         Financial Monitoring of Overseas Visitors Episodes of Care for Recovery of UK Costs
                                                                                                             ALL SECTIONS OF THIS FORM MUST BE FULLY COMPLETED




NHS TRUST
                    ……………………………………………………………………………………………………… PGO No …………………….

LEAD COMMISSIONER ………………………………………………………………
                                                                                                                          ……………………………………………….…………. ORGANISATION CODE ……

                                                                                                                                                                                                                                             Total cost:
                                                                                                                                                                                                                                                                 …..………………………
                                                                                                                                        PATIENT DETAILS


Local Patient Identifier: ......................................................................................................................................................................................................................................................................
                                                                                                                                                                                                                                                                                                              ………...
Patient's Name (Surname/Forenames): .............................................................................................................................................................................................................................................
                                                                                                                                                                                                                                                                                                              ………
Date of Birth: DD/MM/YYYY
                                                .....…../....….../....
Patient's Usual Address:                ..................................................................................................................................................................................................................................................................
                                                                                                                                                                                                                                                                                                              ………...
...........................................................................................................................................................................................................................................................................................................
                                                                                                                                                                                                                                                                                                              ………...
                                                            
Date of arrival in UK             DD/MM/YYYY
                                                                   …/…./…
Postcode of Usual Address                                    (use NHS User Postcode Directory - 5th & 6th                                                                                                                                                                             ……            ……
                                                                                                                                                                                                                                                                                             ..               ..
                                                                                                   (characters only. NOTE the codes may
Patient's Nationality                                        (not be the same in both sections)                                                                                                                                                                                       ……            ……
                                                                                                                                                                                                                                                                                             ..               ..

INPATIENTS and DAYCASES:

                                                                          Start Date: DD/MM/YYYY                       
                                                                                                                             …/…/
                                              End Date: DD/MM/YYYY                                   /          /
                                                                                                 …             …


Diagnosis: Primary (ICD 10 Code):                                    Operative Procedure: Primary

                                                               Operation (OPCS4 Code): 

Specialty Code: 

Health Care Resource Group Code                           ……………….


OUTPATIENTS:


Attendance Date: DD/MM/YYYY                            ....… /....… /....
                                                              ..         ..
Source of Referral:                                               Reason for Referral: 


Outcome:                                                        Specialty Code: 




OTHER CONTRACT DETAILS


Was the patient referred by an overseas authority?                                                                                                                                                                                                                                                YES/NO
If YES and the patient is from EEA: a copy of the E112 must be attached


State Quota number if appropriate: 


Patient's Guide category under which treatment was given                                     …………….




CONTACT FOR ENQUIRIES .......................................................................................................................................... ………………………………………………………
(staff member who completed the form)


TELEPHONE NUMBER/EXT ..................................................................................................................................................................................................................
                                                                                                                                                                                                                                                               ……………………..
PLEASE SEND THIS FORM TO: Overseas Visitor Section                                                                              ,
                                  (Finance Dept) Leeds North East PCT, Sycamore Lodge,
7a Woodhouse Cliff, Leeds LS6 2HF. Tel 0113 3059790 or 3059795 Fax 0113 3059870



                                                                                                                                        Overseas Visitors Policy
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Appendix 13 – Immigration Enquiry

                 NHS IMMIGRATION INFORMATION CONSENT FORM


TO: IMMIGRATION SECURE FAX LINE

Patient name:

Date of Birth:

Country of Origin:                                        Date of Arrival in Country:

Purpose for being in UK:

Home Office Reference or ARC Number (if applicable)



The patient authorises this request:                      Signature of patient:



FROM:

Name of Hospital:



Name & Job title:



Please advise what this person‟s immigration status is

OR

Please advise whether this person‟s ARC is still valid

If no longer valid has asylum claim been

granted ………………………………. OR refused ………………………………………

Please state reason for non-removal from the UK

………………………………………………………………………………………………..




                                                                                              Overseas Visitors Policy
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  Appendix 14 – Payment Schedule Narrative

  The following transactions relate to the Overseas Visitors Hospital Charging
  Regulations 1989.


  Patients name                                                    Ward/Area




  I agree to West Middlesex Hospital charging me for the full cost of treatment as below
  and the attached schedule. I am willing to pay for the cost of the treatment of the above
  as an overseas visitor and the list of charges have been explained to me and I am
  willing to meet these charges. I agree to provide a 50% deposit and I will pay the
  balance over an agreed period as determined by West Middlesex Hospital or their
  representatives.

  I understand that West Middlesex are unable to offer this treatment without making a
  charge. This is in accordance with Regulations currently in force under section 121 of
  the NHS Act 1977 in respect of NHS treatment. Furthermore, I understand that if I
  leave the country West Middlesex University Hospital will take reasonable steps to
  recover the debt using an international debt collection agency and I will be liable for this
  cost also.

  My details are as follows:


              Name

          Signature

            Amount £                                                    INPATIENT STAY AT WMUH/

           Address




        Signed on behalf of West Middlesex
                                       Designation Income Generation Manager
                                                 Date
Copy to be made and handed to patient

Original to be retained in Finance



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Stabilise and Discharge Request Form


Failure or refusal to pay NHS charges as an overseas visitor is in contravention of
section 121 of the NHS Act 1977 in respect of NHS treatment.

It is policy of West Middlesex University Hospital NHS Trust to minimise the financial
loss to the Trust for any patients who refuse to pay for their medical treatment. The
Overseas Visitors Charging NHS Charging Regulations make no provision for unable
or unwilling to pay. Payment for Overseas Visitors charges in the NHS is not optional
and is non-negotiable. It is not within anyone‟s power except for the Secretay of State
for Health to waive a charge for medcial treatment. However in all instances payment
must be made to the treating hospital before any claim for exemption can be assessed.

In order to minimise the financial loss to the Trust, the Medical Staffing Committee
(MSC) agreed that a forum or three Consultants would consider all requests made by
the Income Generation Manager (IGM) to invoke the clause in the Overseas Visitors
Policy of „ Stabilise and Discharge‟. Whereby a patient who is out of the crisis stage of
their illness or disease must be discharged from the care of the Trust. Even if it is not
consistent with the usual clinical pathway.


Consultant 1: (Medical Director)


Consultant 2:


Consultant 3:


Income Generation Manager:


Patients Hospital Number:                                Patients Name:


Charges Outstanding:



Reason for request:


Area of Activity:


Admission Date:                                          Discharge Date:

X1 copy to be filed in the patients notes
X1 copy to be held in Finance



                                                                                              Overseas Visitors Policy
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