another hospital adventure

Thank you for your detail account of hospital info could i ask,  please, how do i pay the Bulgarian health system ? where do we go?

we have a residency card and a house in Bulgaria but at present live in England We would like to spend much longer periods of time in Bulgaria and this is one thing that worries me - health and medicine abroad  could you advise pls  thank you SB

@gwynj

That's really helpful, thank you. Can I just ask a quick question? Do you pay a full health insurance, or top up insurance, or do you just pay as you go?

@sammibenfell18

Once you're a legal Bulgarian resident, you can go do it at NAP/NRA, the social security office. (Once you're in the system, there is also a way to pay online.)

You can make contributions as employed, self-employed, or unemployed. I do that last one, it's about 14 euros per month. (However, unemployed for non-EU citizens is a protected category, they might not let you do this. If you're here 5 years and get permanent residence, then they have to let you. Or, you can do some work, as employed or self-employed, and get in the system that way, and later downgrade to unemployed.)

This entitles you to free, or nearly-free, treatment at PUBLIC hospitals and clinics (similar to the NHS).

However, most (but not all) PRIVATE hospitals and clinics here are affiliated with the system, and get the standard reimbursement from the public system. You just need to pay the difference. This is very unlike the UK, where private hospitals (such as BUPA) are completely separate, and if you want the fancy-schmancy VIP treatment with no waiting, you gotta pay full whack. This really is a fantastic aspect of the Bulgarian system, and the difference between run-down, crowded public hospitals, and almost-empty, shiny new private ones is like night and day. :-)

If you receive a UK state pension, then you can call them and ask for an S1 form. This entitles you to full public healthcare without any monthly payment at all.

You should note that you can also get a free EHIC/GHIC in the UK, which should cover you for public treatment if you have an emergency during one of your Bulgaria visits.

@grumpyoldbird

I personally pay the monthly social security contribution as unemployed. It's 14 euros per month. But folks can also contribute (more) as employed or self-employed.

If you have a state pension (UK, France, etc.) then you can get an S1 form. Then you pay 0 euros per month.

This is for public healthcare, which is free, or nearly free. There is no top-up insurance for this, as you've mentioned for France: such a thing is not needed, as your public treatment is pretty much 100% paid, not 70% paid. Yay, for Bulgaria! :-)

Separately, there are private hospitals for private treatment. You can pay full price, or, if you are in the public system (one of the options above), then the public system pays a good chunk of the cost, and you pay the difference. It's likely to be relatively small.

Additionally, like most countries, Bulgaria has private health insurance policies, which cover you for private treatment. Given the public/private relationship mentioned above, these policies are significantly cheaper if you are in the public system (because the treatment will cost the insurer less).

While I am in the public system in anticipation of bad news... to date (6 years), I have always wandered into the nearest private hospital... demanded to get X right now (just kidding, I ask very nicely)... and then paid the full private bill. So far the bills are astonishingly small.

My GP is in Medline too. His private consult is 25 lv. If you're in the public system it's 5 lv. He's a great doc, extremely helpful, and a bargain for 12 euros... I can't bring myself to complain and get it down to 2 euros. But you might be more ruthless than me. :-)

@gwynj

Thanks for that. I do have an S1, which requires top up in France. That all sounds very promising and I'm not ruthless enough to argue over a few lev.

@grumpyoldbird

My GP is a sweetheart, I doubt you'd have to argue. If you register with him, and he knows you're a pensioner and you've got an S1, I'm sure he'd only ask for the 5 lv (or less).

To be scrupulously honest, I have yet to pay him even 25 lv. He has so far refused to take any payment at all. I say I booked an appointment, it's not his fault I only wanted to register, or get some information, or get a referral. He says there's nothing wrong with me, and he didn't have to do anything, so no charge. :-)

@gwynj

which hopsital does the mri?

Wow, impressive, Gwyn, especially considering the experience we've just had trying to get a cardiology appointment for hubby here in the UK. Ot was for something that wasn't quite A&E but close. It needed to be treated within days but not necessarily within hours.

It's all sorted now, but he had to wait weeks and do a lot of chasing himself. First the hospital doctors were on strike, so the normal medical assessment unit the GP would have sent him to wasn't open. Then it was discovered that the urgent request the GP sent directly to the local cardiology unit was lost. Hubby ended up completely breaking the rules and emailing the NHS cardiologist directly, who responded fabulously well and set everything up to get hubby assessed the following day. He now has a shiny new pacemaker!

If we'd been in Bulgaria when this happened, he could have gone straight to the cardiologist same day the problem started and avoided a few rather anxious weeks of waiting.

@janemulberry

The UK system, especially now that it's so overloaded, is a bit like wading through treacle.

As I've had the same condition for many years, I've done the same process in the NHS... and it took over a year to get the consult and the x-ray (and didn't give me an MRI, as they're cheapskates).

Cardiology is pretty stressful stuff, sorry you had to deal with that. I don't know if you spotted, but I posted a couple of months back about my cardiology experience too. I would never even even ask my GP in the UK - as I'm not ill, so there's no way I'd get a referral to a cardiologist! But here I waltzed in (Medline, same hospital), and got the full works from a proper cardiologist (physical exam, blood pressure, discussion, ultrasound, EKG, echocardiogram). Gave me all the results and a written report. Consultation fee + tests + report: 70 quid or so. Full price. Honestly, I found it hard to believe.

But Medline is a private hospital. Obviously, it's a different story in a Plovdiv public hospital, they're crowded and a bit shabby, just like many UK hospitals. I'd struggle to find an English-speaker there, and I would not be able to do anything without the GP guiding me, and providing the appropriate referrals. I know folks who have had great treatment at public hospitals here, but the private option is so easy, and so good, and so cheap... it's a bit of a no-brainer.

@Anastasija_gust

I was at Medline. But I've had one at Pulmed a few years back. I think most hospitals have standard scanning equipment (X-ray, CT, MRI), and I don't think there's any problem getting one if you want/need one. Either privately as I've done (more expensive, but no waiting), or via your GP and a referral (bit slower, but almost free).

all sounds really good is there a midline in Varna

l am registered in the system as a pensioner but havnt seen a doctor in BG in the last 10 years ??

sorry Medline 😞

@Truetomyself

Glad to hear you've been as fit as fiddle for years, long may it continue!

However, I think it's a good idea to find yourself a local doc and register with him as your GP. I don't speak Bulgarian, so I had to shop around to find one who was good and spoke English. If your Bulgarian is tip-top after 10 years, you'll have a wider choice. Your GP is the gateway to the public system, as, for many issues, you'll probably need a formal referral. If you go to a private hospital, you don't need a referral (but it will be cheaper if you have one). For emergencies, I guess public hospitals will look after you for free, or you can go to a private hospital if you're happy to pay a bit extra.

As well as tracking down a plausible GP, I also popped into several of my local hospitals to see what they were like, and to find out how helpful (temperamentally and language-wise) they were when I tried to do something (blood tests, scans, health assessments, see a specialist) there.

Even if you're not a big fan of doctors, you can do a bit of a self-check very easily. Blood pressure is a big deal, you can get cheap monitors online or at a pharmacy. Ramus Labs is nationwide, including Varna. You just do a fasting (overnight) blood test, by showing up at 8 am when they open. Their RAMUS MEGA (15 euros) has the important stuff, including blood glucose and cholesterol panel, and it's better than you'd get in the UK from a GP there (and way quicker/easier). I add a bunch of hormone levels and cancer markers which bumps it up to 60 euros. They put the results online a few hours later. If anything's out of whack, you can follow up with a doc.

Plovdiv is a bit of a medical centre, so there are several big hospitals here. For non-emergency treatment, nothing stops you from going to Sofia or Plovdiv. Varna is a big city, so I'm sure there are decent hospitals there too.

https://visit.varna.bg/en/in_case_of_emergency_varna.html

thanks for the info

l don't drive so local is better

and l guilty add my Bulgarian is Rubbish

thank goodness for Google translate

Based on the local health insurance also good idea to get the free European Health Insurance Card EHIC, which covers you on travels around EU. Fibank has been tasked by BG NHIF to issue those, form only in Bulgarian, but often bank clerks help to fill it out.

Very good subject and lots of useful information so thanks to all .. my wife had IVF last year so I already know that private hospitals are very reasonable and extremely helpful  to you

@gwynj Yes,I was thinking of your cardiology experience while we waited for things to happen here!

The cost to go private in the cardiology clinic our neighbour recommended is a bit higher -- I think Varna does more medical tourism so the prices are a little inflated -- but well within what we could afford. To have what you had done would be nearer 200 leva there.

Even getting the pacemaker done privately there would have been just about affordable. Getting it done privately here would have wiped out every penny of my house renovation budget and then some! I'm glad the NHS came through for us in the end. The actual cardiology team were excellent. It was just dealing with the admin to get there that was the issue -- and them losing the paperwork didn't help!

Sometimes the prices are inflated on the coast and maybe in the cities because the providers think that you'll be able to claim the costs off insurance.  I learnt this while trying to find a dentist and ended up going local in Pomorie.

@janemulberry

Yes, unfortunately, until you get the D visa and Bulgarian residence, you can't enroll in the public health system. Even if private treatment here is relatively inexpensive, it can still be a significant chunk of change if you have to pay full price. It's the public system subsidy (once you are in the system) which makes it such a great deal. Until that day arrives, I'm sure the NHS will serve you well. However, I'd grab a UK EHIC/GHIC (you probably already have it) so that health issues are covered during your regular trips over here to work on your house.

Definitely we both have our GHICs. Like American Express - don't go anywhere without it (or whatever Karl Malden used to say on the ad!)