Biaya Operasi Apa Saja Yang di Tanggung dan Tidak di Tanggung BPJS Kesehatan

Hanya BPJS Kesehatan yang siap menjamin hampir semua jenis penyakit yang di derita oleh pesertanya, termasuk biaya pengobatan sampai peserta tersebut sehat.

Ada yang bertanya, biaya operasi apa saja yang di tanggung BPJS Kesehatan ? jawabannya, semua jenis operasi di jamin oleh BPJS Kesehatan, asal mengikuti peraturan, sesuai prosedur dan tidak punya tunggakan iuran setiap bulannya. Karena sesuai dengan pedoman pelaksanaan JKN, dalam hal ini PMK No 28 tahun 2014 semua dapat di tanggung oleh JKN kecuali yang di sebutkan secara ekplisit dalam manfaat yang tidak dijamin dalam program JKN.

Jadi, semua operasi yang bentuknya pengobatan dapat di tanggung oleh BPJS Kesehatan. Yang penting peserta mengikuti prosedur pengobatan yang di tentukan oleh BPJS Kesehatan yaitu peserta di haruskan periksa ke faskes 1 (Puskesmas/Klinik) terlebih dahulu. Jika memang peserta membutuhkan operasi, maka dokter yang bertugas di faskes 1 (Puskesman/Klinik) akan memberikan surat keterangan rujukan ke Rumah Sakit. Dirumah sakit, peserta akan di periksa oleh dokter spesialis kemudian akan ditentukan jadwal operasinya.


Supaya peserta di layani di Rumah Sakit, ada 3 dokumen yang wajib di bawa peserta BPJS Kesehatan  yaitu peserta di wajibkan membawa kartu BPJS Kesehatan, Surat Rujukan dari faskes 1 dan kartu pasien (jika belum punya, harus mendaftar dulu).

Nah, berikut ini daftar operasi yang di tanggung BPJS Kesehatan sesuai informasi yang kami ketahui :

  1. Operasi Jantung
  2. Operasi Caesar
  3. Operasi Kista
  4. Operasi Miom
  5. Operasi Tumor
  6. Operasi Odontektomi
  7. Operasi Bedah Mulut
  8. Operasi Usus Buntu
  9. Operasi Bedah Empedu
  10. Operasi Mata
  11. Operasi Bedah Vaskuler
  12. Operasi Amandel
  13. Operasi Katarak
  14. Operasi Hernia
  15. Operasi Kanker
  16. Operasi Kelenjar Getah Bening
  17. Operasi Pencabutan Pen
  18. Operasi Penggantian Sendi Lutut
  19. Operasi Timektomi
  20. Dan Operasi Lainnya, selain operasi dibawah ini

Operasi yang tidak di tanggung BPJS Kesehatan :

  1. Operasi Kecelakaan Lalu lintas, karena sudah menjadi tanggung jawab Jasa Raharja
  2. Operasi diluar Negeri
  3. Operasi yang tidak sesuai prosedur
  4. Operasi karena kecelakaan kerja, karena sudah menjadi tanggung jawab BPJS Ketenagakerjaan

Berapa Tarif Operasi Penyakit Yang ditanggung BPJS Kesehatan?

Untuk masing-masing operasi ada tarifnya tersendiri. Sesuai sistem INA-CBGs tarif dibedakan berdasarkan kualifikasi rumah sakit (rujukan nasional, kelas A-D), kelas perawatan (BPJS kelas 1-3), regional rumah sakit (regional 1 – 5), dan tingkat keparahan (berat-sedang-ringan).

Agar Biaya Operasi Ditanggung BPJS Kesehatan Sebaiknya:

Peserta harus rutin membayar iuran BPJS Kesehatan setiap bulannya dan mengikuti prosedur berobat, yaitu peserta harus berobat terlebih dahulu ke faskes 1 (Puskesmas/Klinik), kemudian jika memang membutuhkan perawatan lebih serius (operasi), dokter yang bertugas disitu akan memberikan surat rujukan ke rumah sakit. Di rumah sakit, Peserta akan di periksa dokter spesialis kemudian memberi jadwal untuk di lakukan operasi.

Saat peserta mendatangi Rumah sakit, peserta wajib membawa dokumen yang telah di tentukan yaitu kartu BPJS/KIS, kartu pasien (jika belum punya harus daftar pasien baru), dan surat rujukan dari puskesmas/klinik.

Bagaimana Jika Peserta mengalami kondisi Gawat darurat ?

Untuk peserta dalam kondisi gawat darurat, peserta dapat langsung di bawa ke rumah sakit tanpa harus membawa surat rujukan dari faskes 1. Jika kondisi peserta tersebut membutuhkan operasi, maka dokter dapat langsung melakukan operasi. Yang terpenting bagi pasien adalah mendapatkan pengobatan dari fasilitas kesehatan, untuk urusan tarif merupakan urusan klaim antara RS dengan BPJS, pasien tidak boleh ditarik iuran biaya jika sudah sesuai prosedur.

Demikian informasi yang dapat kami berikan, semoga bisa bermanfaat. Salam…

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