Healthcare Provider vs. Health Fund

From Rejection to Successful Settlement — Chronicle of a Customer Complaint

In the world of health fund settlements, we often encounter difficulties when service providers don't know or properly apply the relevant rules. In this case, I report on a weeks-long struggle during which I managed to get an initially rigidly rejecting healthcare provider (Buda Eye Center) to eventually cancel previously issued invoices and reprint them in the appropriate format for settlement with the health fund.

The story is instructive from several perspectives: on one hand, it highlights the pitfalls of the health fund settlement system, and on the other, it provides an example of how persistent but constructive communication can achieve results even in situations where the service provider initially refuses to cooperate. The case also illustrates that people, companies, and staff are often unfamiliar with billing rules, don't know what a corrective invoice is and what a cancellation invoice is, and when to apply which. It's particularly concerning that some companies brazenly ask for high amounts (in this case up to 300,000-400,000 HUF) for performing basic operations that are actually simple administrative tasks. Even more serious is when accounting professionals and auditors act unethically and make false statements - especially against me, who has more than 20 years of experience in implementing and operating healthcare and IT systems.

Why Did the Health Fund Issue Come Up Now and How?

The eye surgery took place in December 2023 and January 2024. At the end of January 2024, shortly after my birthday, I was contacted by an agent who dealt with insurance and various contracts.

During the conversation, we went through insurance options, but since I am familiar with the financial and insurance sector as a cybersecurity expert and salesperson, I indicated that my own insurance policies were in order. The gentleman then offered me to take out insurance or a health fund for my family members.

I told him that my mother is alive, but my father passed away in 2007, and my grandparents died in 2007, 2018, 2019, and 2021, respectively. I knew I could add my mother to the health fund, but I wasn't sure if this was possible since she lives in Romania and doesn't have paid social security in Hungary. The agent confirmed that this could still be done, as I could claim the 20% refund for her healthcare services from my own personal income tax.

After this happened, I started a new project: contacting all healthcare providers who had performed treatment or diagnostics for my mother in Budapest over the past two years. The list was quite long: in addition to the current cataract surgeries, there were previous CT, MRI, rheumatology examinations, blood tests, and other procedures.

The Beginning of the Problem: My Mother's Cataract Surgery

In December 2023 and January 2024, my mother (Stefania Bako) underwent cataract surgery at the Buda Eye Center. After the treatment, I wanted to settle the invoices through health fund settlement, as I had set up my mother as a dependent on my account at the PREMIUM Health Fund. The total amount was about 665,000 HUF, where the 20% tax benefit would have represented a significant saving of about 130,000 HUF.

The problem began when I indicated by phone to the reception in early February 2024 that I would like to receive the invoices rewritten to the health fund. I initially received a positive response, but soon got a rejecting email: "We are unable to issue a health fund invoice after the surgery."

Beginning of a Long Communication Process

After the rejection, a multi-step communication process began:

1. I contacted customer service, then the managing director of the Buda Eye Center.
2. The provider initially claimed that modification was no longer possible for the December invoice because "the month is closed."
3. Surprisingly, during a phone consultation, they informed me that canceling and reissuing the invoices would cost 300,000-400,000 HUF - all for an operation that is normally a 10-minute administrative task. According to the company, this process requires at least 10 hours of work, which is a completely absurd claim.

Questioning Auditor Expertise

Based on the company's extract, I also contacted the auditor to clarify the situation. From the correspondence, it became clear that the auditor claimed there was no law that would obligate the provider to cancel the invoice. They asked me to cite the relevant law for them, as they were not familiar with it - which is particularly shocking for an auditor.

After several exchanges, the auditor still insisted I cite a specific law, while they themselves couldn't explain why invoice cancellation wasn't possible. Eventually, I had to involve the Hungarian Chamber of Auditors (MKVK) in the case to clarify the professional questions.

To reinforce my position, I consulted several experts: I inquired at the Tax Authority, who confirmed that based on VAT Act Section 170, invoice cancellation is a completely regular and permitted procedure, even for older invoices. The consumer protection authority and the health fund itself confirmed that this is a common and legitimate request that the provider must fulfill. I also found the relevant information in several billing software documents: "You can issue a cancellation invoice even months after the original copy was prepared."

Data Protection Concerns

During the case, numerous data protection concerns also arose, which are at least as alarming as the invoice issue itself:

• The managing director corresponded with me from their private Gmail address (@gmail.com), which calls into question the healthcare provider's confidentiality practices.
• This potentially allows patient data to escape their control and systems, which is a serious error and could result in severe penalties.
• The auditor communicated from a personal domain (@personalname.hu), which is unusual in a professional context.
• I received no information from the auditor about how they handle my personal data, for how long, and for what purpose.
• The auditor's website didn't work, and there was no visible data management or privacy statement in the emails.
• The healthcare provider's website still had a 2018 privacy notice in 2024, which is more of a data processing notice and doesn't comply with current regulations.

All this seriously calls into question the legality and transparency of the data processors' operations, especially in a sensitive area like healthcare.

Solution and Lessons