Vademecum Waiting lists

Art. 32 of the Italian Constitution. “The Republic protects health as a fundamental right of the individual and interest of the community, and guarantees free treatment to the indigent. No one can be forced to undergo a specific health treatment except by law."

The total ineptitude of a majority of Italian politicians, combined with a medical profession aimed almost exclusively at private interests and a clear desire to privatize the Healthcare System, has led to a radical reinterpretation of Article 32 of the Constitution: treatment is increasingly a luxury for those who can afford it and the so-called Republic protects everything except the rights of the individual. 

As you know, we deal almost exclusively with combating every form of vaccination obligation, but the Covid19 pandemic, with the related repressive and blackmail policies on vaccination obligations, has left behind an enormous number of people with very serious health problems, to whom Added to this is a healthcare system close to collapse, with biblical lengthening of waiting lists for specialist visits or diagnostic tests.
Anyone who has gone to a CUP (One-Stop Reservation Centre) desk to make a reservation for a service has been told that there won't be any space available for many weeks, months or even years. In the most extreme cases, booking activities were even suspended.
For these reasons it seemed important to us to offer you some tools to be able to deal with at least the age-old problem of waiting lists, and to do so we have collected in this article the current legislation and some forms that we are sure will be useful to you.

Before going into the specifics of how to defend your right to health, let's clarify what the law states: if the maximum waiting times for a medical visit exceed those established by law, the law provides that the health company must indicate to the citizen the accredited (agreemented) public or private structures that ensure compliance with the timing; if no public or affiliated structure is able to provide the service, theThe health company must authorize the service under the intramural regime (intramoenia) and in this case the citizen does not have to bear any additional economic burden, other than any ticket (if not exempt).
We tell you more: we have clear proof that often just making it known that you know your rights, combined with a certain amount of polite but immovable determination, means that by magic a place appears on that list that was closed to you.
What if the lists are blocked? Also in this case the law gives you the right to intramoenia service by always paying only the ticket, if due.

Now let's get to the details

The rule that indicates how you can exercise your right to be treated is the Legislative Decree 29 April 1998, n. 124,⁽¹⁾ in particular its Art. 3, "Methods of participation in the cost of services". In addition to this Legislative Decree, more concretely reference must be made to National waiting list governance plan for the three-year period 2019-2021 (PNGLA)⁽²⁾ which determines the operating methods and the list of outpatient specialist visits and diagnostic services.
Even if you live in particularly naughty regions, those regions whose health authorities use the trick of suspending the booking of specialist visits, often to direct users to the same health facilities (within which, however, there are doctors who operate under the intramoenia regime) , L'Art. 1, paragraph 282, of the Law of 23 December 2005⁽³⁾ specifies that the suspension of service booking activities is expressly prohibited.
Lastly, theArt. 3, paragraph 8, of Law 23 December 1994 n. 724,⁽⁴⁾ provides for the obligation to keep a register of outpatient specialist services, instrumental and laboratory diagnostics, and ordinary hospital admissions.

To be able to protect your right to health, however, you must know some more "technical" aspects, but do not fear: nothing is impossible and above all they are things that for better or worse you have already seen or heard.

To begin, it is worth knowing that the prescribing doctor, whether a general practitioner, a paediatrician of free choice or another professional figure, must necessarily indicate three elements on the (mandatory) medical prescription:

• if it comes to first visit (or first exam) or of subsequent access/control;
• the diagnostic question with which he describes the health problem that motivates the request to carry out the healthcare service;
• the priority class.

The latter defines the times for accessing healthcare services and is divided into four priority classes for the first visits and for the first access diagnostic and instrumental tests, priority classes which are crucial for understanding the certain times established by law, those times that the healthcare company is required to guarantee:

• U (urgent) - to be carried out as quickly as possible and, in any case, within 72 hours. In some regions, such as the Veneto Region, this type of priority class cannot always be booked through the CUP and for some diagnostic tests or specialist visits you are sent directly to the emergency room with the prescription showing the urgency class U. We advise you to contact the CUP and ask if the service passes through the emergency room or proceeds with the normal procedure.
• B (short) - to be carried out within 10 days.
• D (deferrable) - to be carried out within 30 days for visits or 60 days for diagnostic tests.
• P (programmed) - to be done by within 120 days.

If the priority class is not indicated, the service requested is to be considered class "P".

There are four others priority classes relating to scheduled hospitalizations, namely: 

• AT - Hospitalization to be carried out within 30 days. It is indicated in clinical cases that can rapidly worsen to the point of becoming emergent or causing serious damage to the prognosis.
• B - Hospitalization to be carried out within 60 days. It is indicated in clinical cases that present intense pain, serious dysfunctions or serious disability but which do not show a tendency to worsen rapidly to the point of becoming emergent nor can, due to the wait, suffer serious damage to the prognosis.
• C- Hospitalization to be carried out within 120 days. It is indicated in clinical cases that present minimal pain, dysfunction or disability but which do not show a tendency to worsen nor can, due to waiting, seriously prejudice the prognosis.
• D - Hospitalization without a defined maximum wait. It is indicated in clinical cases that do not cause any pain, dysfunction or disability. These cases must however be carried out at least within 12 months.

Including the priority classes, we come to the monitored exams. To do this we use the National waiting list governance plan for the three-year period 2019-2021 (PNGLA), which establishes the list of outpatient services and ordinary or day hospitalization services, as well as some tightening of compliance with certain times, such as the possible blocking of intramoenia activities if waiting times are not respected, or the removal of General Directors. In short, on paper everything is wonderful, but we assure you that you will have to put in a pinch of determination to get some ears to start listening to you.

For simplicity we have listed the 14 specialist visits, the 55 instrumental services and the 17 ordinary or day hospitalization services identified by the PNGLA:

What to do if…

Before proceeding, let's recap what you need:

• Challenging recipe showing one of the 4 priority classes;
• the prescription (mandatory) is for a specialist visit, instrumental service or service under ordinary or day hospitalization included in those listed by the PNGLA.
• lots of patience.

Do you have a (demanding) prescription for a visit and the CUP provides you with the first useful date well beyond the times foreseen by the priority class assigned by your doctor? Arm yourself with patience and let's start explaining what to do.

Attention! Before demanding a first visit or a first diagnostic test in a freelance profession due to excessively long waiting times in the public service, you need to know that there is an exception. If the CUP proposes a structure capable of providing the healthcare service within the times established by law but the patient does not accept it because he would like a structure or even a Region different from that of residence, the right to the maximum guaranteed time is lost.

Do you have a (demanding) prescription for a first visit and the CUP provides you with the first useful date well beyond the times foreseen by the priority class assigned by your doctor? If you are in this condition you must get it into your head that even if you are right you must not lose patience at the first refusal. Ensuring that all citizens have certain access times to healthcare services that are adequate for clinical problems represents a primary objective of the National Health Service and we just need to remind them of this. Below we will explain step by step how to do it with the relevant modules, but we repeat it: to date, in most cases it has been enough to remember, with polite decision, what our rights are and what their duties are and, by magic, a free position has appeared.

Having said that, once you have received from the CUP a date well beyond the times foreseen by the priority class assigned by your doctor, you will have to ask the same CUP to guarantee the provision of the healthcare service within the expected priority times and within the territorial scope, also through the intramural freelance-professional activity regime, as provided for by the Art. 3, paragraph 13, of Legislative Decree 124/98. Underline that, in accordance with the provisions of Article 3, paragraph 12, of Legislative Decree 124/98 and the regional legislation implementing the National Government Waiting List Plan 2019-2021, you have the right to receive the service at a cost of responsibility of the National Health Service, with the exception of the payment of the health copay where due. Also ask that you be provided with timely communication in this regard (5 days from the date of shipment) advising that, if lacking, the aforementioned service will be carried out privately with a subsequent request for reimbursement to be paid by this company.
If the CUP does not resolve the situation, contact the URP communicating the same issue plus the date proposed by the CUP for the healthcare service.

NB At the bottom of the article you will find all the downloadable and editable forms.

A good percentage of those who carried out this procedure, communicating only verbally with the CUP or the URP, obtained the service in times compliant with the date referring to the priority class, but not all regions are the same: if this were not enough then you will have to send written request to the General Management of your healthcare facility of reference, generally the ASL, AUSL and in Lombardy the ASST, copying the URP (Public Relations Office), the CUP (Single Booking Centre), the RUA (Single Contact for Access) and, where existing, the Public Protection Office (UPT) - the email addresses are public and can be found on the website of the individual healthcare companies - indicating: the exceeding of the maximum waiting times, the urgency of the service, the need to respect the Art. 3, paragraph 12, of the Legislative Decree. 124/98 and the PNGLA 2019-2021.
At the same time you will have to ask to take advantage of the benefit under the regime of intramural freelance activity; to receive immediate feedback on the request and, in the absence of an intramoenia booking, to receive the service privately with advance notice of a subsequent request for reimbursement from the ASL (we remind you that the booking must in any case be made by the CUP).

What if the General Management does not respond? You have ended up booking a visit privately or as a freelancer and having to request a refund, which means you have tried all the previous methods and, unfortunately, to no avail. We do not want to push you into legal litigation and our hope is that most of you have resolved it before reaching this point, fighting independently and without spending money. We also know that everything depends on the region in which you live: demanding a healthcare service in Veneto or Trentino is not like demanding it in Campania, Sicily or Puglia.⁽⁵⁾ Not only that, according to a survey by Altroconsumo (May 2022)⁽⁶⁾ 81% of Italians had difficulty booking visits and tests with the NHS due to long waiting lists: 65% had to go private and 5% even had to give up treatment. 

Having said this, once the visit, examination or hospitalization has been carried out in a private facility or in a freelance activity, outside the National Health Service, you will have to request the General Management of your reference healthcare facility by copying, once again, both the President of your region and the competent department (in Veneto it is the Councilor for health and socio-health planning), also attaching to the request a copy of the invoice and the previous request for the provision of healthcare services pursuant to Art. 3, paragraph 13 of the Legislative Decree. 124/98. 

What if the CUP tells you that the waiting list for the service you have requested is blocked? Also in this case we urge you to report the fact to the General Management of your healthcare facility of reference by copying, once again, both the President of your region and the competent department (in Veneto it is the Councilor for Health and social-health planning ), requesting the unblocking of the lists and the application of the sanctions provided for by law. In fact, remember that it is not possible for the providers to close the availability of booking diaries and therefore the latter must always be open. The closure of booking diaries is prohibited by Law 266/2005 (Financial Law 2006, Art. 1, paragraph 282)⁽⁷⁾ and non-compliance with this provision provides for administrative sanctions for violators, i.e. the relevant healthcare facility.

We will continue to monitor the situation of impossible waiting lists and we will proceed in our battle for freedom of choice in the therapeutic field also through the reconquest of all those rights that have been denied to us for too long, such as the right to health.

Corvelva Staff