Referral or self-pay: how to decide

The rule is simpler than it seems. Most clinics at Medicinski center Ljubljana are self-pay: you do not need a referral and you book yourself, without seeing your personal doctor first. A referral only counts at those clinics that also work under the public health insurance scheme of the Health Insurance Institute of Slovenia (ZZZS), and even there only when you want treatment covered by compulsory health insurance. Who pays for a service therefore does not depend on how serious your problem is, but on which clinic treats it.

The clinics at the centre covered by public health insurance (ZZZS) are the family medicine clinic, the paediatric clinic, the dental clinic, the gynaecology clinic (women’s health clinic), gastroscopy and colonoscopy, and the pulmonology clinic run by Objem zdravja. All other clinics at the centre are self-pay. Each clinic’s page states what applies to it.

The first four listed are the entry point into the health system, and you do not need a referral for them even as an insured person. Instead, you register with the doctor, which you do by signing a declaration of choice at the clinic, and you bring your health insurance card. The self-pay route at these clinics remains available to those registered elsewhere.

Gastroscopy and colonoscopy are different. Both tests are carried out with a ZZZS referral and on a self-pay basis. With a referral you book through the booking for referred patients; without one, you book as a self-paying patient. Whichever route you take, a doctor assesses the test beforehand, checking whether there is a sound reason for it and whether it is suitable given your other conditions.

In pulmonology, the difference depends on the provider. The clinic is run by two providers; a self-pay examination is available with both and you do not need a referral for it. Care covered by ZZZS is provided by Objem zdravja, so with a referral from your personal doctor you book directly with them.

A referral is issued by your chosen personal doctor (GP) and is valid for treatment by a specialist. If you already have a referral but the clinic is self-pay, bring it anyway, together with your personal doctor’s report. It does not affect payment, but it contains information that is useful to the specialist and often saves repeating tests.

The self-pay route has its own logic even for people who are fully set up in the system. It is useful for a second opinion, for a consultation about a problem that cannot wait long, and for treatment when you are registered with a doctor elsewhere. Give the report you receive after the examination to your personal doctor; they manage further treatment and, if needed, issue a referral covered by insurance. Some services are not covered by ZZZS even at clinics that otherwise are; dental hygiene is one example.

Booking is managed by the provider that runs the clinic, and you can also check the price of a self-pay service with them. Appointments cannot be booked on this site; the link at each clinic takes you straight to booking with the right provider.