Officialization 13: Going to the doctors

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They were randomly giving out free watermelon in Rovereto the other night (no strings attached, not even an advertisement), and storing the watermelons in the fountain!

Officialization TOC

  1. Officialization 1: WTF comes next in Italy?
  2. Officialization 2: Apartment
  3. Officialization 3: Internet
  4. Officialization 4: Stay Permit, part I
  5. Officialization 5: Picking Courses
  6. Officialization 6: Stay Permit, part II
  7. Officialization 7: TV Tax
  8. Officialization 8: Stay Permit, part III
  9. Officialization 9: Residenzia
  10. Officialization 10: Health Insurance
  11. Officialization 11: Thesis Registration
  12. Officialization 12: Stay Permit, part IV
  13. Officialization 13: Going to the doctors <– You are here

TL;DR

The process for getting national health service benefits is a hassle. The fees are pretty low though, even compared to the ones in Germany, and certainly compared to the fees in the US.

  • Process:
    1. Get your stay permit (i.e. at least 4-5 months after arriving in Italy), so you can sign up at Anagrafe with a general practitioner, and receive your “tessera sanitaria” (national health insurance card)
    2. Show up at the GPs office hours exactly when they open or you’ll have to wait. There’s no formal queue– ask who is waiting for your doctor; you are behind the last person.
    3. Get a normal medication prescription if needed, and pick it up at a pharmacy.
    4. Take initiative to request a prescription for special tests if needed.
      1. Show up at the hospital exactly when they open.
      2. Wait in one line to pay. Wait in a second line to get the test.
      3. Go back to the hospital/ your doctor after a week or so to receive your results. (They can only call you to tell you that they’re ready if you have an Italian phone number.)
      4. N.B.: Blood work can be scheduled via Telegram (info here) so you don’t have to wait.
  •  Insurance Fees:
    • US: $10-15 / month (but my employer paid the larger share, otherwise it’s hundreds of dollars per month)
    • Germany: €90 / month
    • Italy: €150 for the calendar year
  • Synthetic thyroxine medication:
    • US: $10-15 / month
    • Germany: €5 / three months
    • Italy: €15 / three months
  • Doctor’s appointment with blood work:
    • US: $100-150
    • Germany: €0
    • Italy: €35

Going to the doctors

I’ve had to go to the doctor a few times now in Italy. The process has not been as smooth as last year in Germany. I admit that after all this time, I still haven’t fully understood how the health system is supposed to work here. There seem to be two classes of health care, public and private. As I understand it, though I haven’t tried, for the private health care, you can call any doctor you want directly, and set up an appointment, and just pay for the meeting out-of-pocket. However, so far, I have used the public services, using the “tessera sanitaria” (national health care card) that I received earlier in the year.

The way the public services work is first you pay for the insurance and then you sign up with a general practitioner who will be your doctor. They will be the person you first visit for any issue, and they can send you along to further specialists. The way you visit with them is just the same as the way you do anything in Italy… by getting to their office before everyone else. All the public doctors seem to have open office hours on a first-come first-served basis. I cannot stress enough that you need to arrive immediately as they open, or a couple minutes before, in order to get to see them in an expedient way.

So you arrive as they open, and just walk into the doctor’s office. In terms of the queue, if there are already people waiting, you should try to ask who is waiting for your doctor; some may be waiting for other doctors who share the office (if you don’t speak Italian well, you can just say your doctor’s name, and people will probably understand your question). Then, remember who you are behind, and take a position in front of the doctor’s door after they go in.

You tell them your problem. If you have pain or something that requires antibiotics, they write you out a prescription for ibuprofen or antiobiotics or cream or whatever, and you take it to the pharmacy. Otherwise, they tell you to wait and see. Usually, that’s your entire appointment. It’s rarely very helpful. By the way, if you don’t have a tessera sanitaria, they aren’t supposed to write you a prescription, but my doctor seems to be pretty willing to bend those rules.

If you actually know what your problem is, you can ask the doctor to request tests to be done if you need them. In my case, I am hypothyroid. The first few times I went, I just asked for the same medication that I always take, and my doctor just wrote me a prescription (the very first time I didn’t even have my tessera sanitaria yet, but he just said not to worry about it). Recently, though, I decided I should check my blood levels again, to make sure everything is still on track, since it’s been a while. Note, that I decided this. In the US, my doctors would know me as a patient and they would know my history, so they would occasionally suggest that I get such tests done, in particular if I had other problems going on as well, or if it’s been the requisite amount of time since the last one. Here, although I have been with this doctor since the start, he doesn’t suggest such tests at all. It’s up to me.

So I asked him how to get the blood work done. My doctor doesn’t have a lab in his office and I believe most public doctors don’t, at least in small towns like Rovereto. So he gave me a prescription and told me to go to the hospital for this, where they have the labs to do it. You can apparently schedule blood work appointments via Telegram (info here), but I didn’t know about that at the time.

Thus, I went to the hospital in person. The procedure there was not at all straight forward. The first day I went, I couldn’t find the correct place to go. I entered through the main entrance and tried to understand the signs for the departments (things like gynecology, cancer, and so on). None of them suggested to me that they did blood work for normal issues. I went to the Segreteria (secretary’s office) to ask them. The lady there was one of the first people I’ve met in Rovereto/Trento that didn’t make much of an effort to make herself understood. If I can’t understand someone right away, I always tell them that I don’t speak Italian that well, and this usually gets them to speak slower or use simpler words. This lady really didn’t care about that. It took me more running around, and asking of other workers (at random) to finally understand that the office was only open from 7:30 till 9:30am, but I still didn’t fully understand its location. In any case, I had to come back another morning.

When I came back, I very fortunately ran into a friend coming out of the hospital. She explained to me that the entry for the blood work was in a different place on the side of the building. I finally found and entered the secretary’s office for outpatient procedures such as blood work (“prelievi del sangue”) around 8:15am. As soon as I entered that room, I realized I had come too late. I knew right away that I would miss the last train to work before the morning break, which comes at 9:37am. This is because the room was filled with people waiting in seats. A number queue monitor called numbers from different needs categories, and the blood draw category was definitely low priority (I think pregnancy-related issues were highest priority). Still, I was already here, so I decided to wait.

Around 45 minutes later, I guess, my number was called. I went up to the secretary, and found out I would have to pay around 35 euro for the blood draw, before getting it done. I did this, and received my receipt. She sent me along to the next room. To my chagrin, I realized that all those people that had just waited in front of me, were now seated in this second room, awaiting their blood draw appointments. I would have to wait again. Not only that, but if I left, I would have to get a refund for the cost of the blood draw, and then re-do this whole process later. So I decided to wait.

Maybe half an hour later, I was finally called in. The blood draw was done by a skilled nurse, and it took all of 1-2 minutes, as usual. Nice and fast.

For getting the blood work results, the hospital will call you– that is, unless you don’t have an Italian phone number, in which case, like most government offices, they can’t understand how to call you. In my case though, the results were thankfully sent to my doctor electronically. He also doesn’t seem to be able to call non-Italian numbers, so I still had to go to him another morning to find out the results. Why not use E-mail you ask? Good question; I have no answer.

By the way, I didn’t manage to catch my 9:37 train, however, there was one more train coming at 9:43. This was the German train going up to Munich, and it would cost me some 6.30 euro or so, if I could catch it. However, by the time I got to the platform, I couldn’t pay for the train anymore, neither at the machine, nor on the train apps, nor at the counter, because the hour the train should arrive was past– even though the train itself was also late (fortunately for me). The lady at the counter told me to pay on board, which I’m sure would have been pretty expensive. Still, I decided to risk it. Sometimes they don’t check tickets. I caught the train, and indeed, no one checked tickets that day.

What a hassle this day was!

 

 

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Officialization 10: Health Insurance

Antifa street art in Bologna.

Officialization TOC

  1. Officialization 1: WTF comes next in Italy?
  2. Officialization 2: Apartment
  3. Officialization 3: Internet
  4. Officialization 4: Stay Permit, part I
  5. Officialization 5: Picking Courses
  6. Officialization 6: Stay Permit, part II
  7. Officialization 7: TV Tax
  8. Officialization 8: Stay Permit, part III
  9. Officialization 9: Residenzia
  10. Officialization 10: Health Insurance <– You are here
  11. Officialization 11: Thesis Registration
  12. Officialization 12: Stay Permit, part IV

Health Insurance

I paid for the Italian national health insurance for 2018 when I was first applying for my stay permit. Now that I received my stay permit, it was time to actually sign up for the insurance.

This is done at yet another government office, separate from the others, called the Agenzia Sanitaria. I received a copy of the form called Azendia Provinciale per i Servizi Sanitari, which I had to fill out from the Welcome Office at school, but they neglected to tell me the Italian name or full address of the office. Without the Italian name, I had some trouble googling the location, but I finally found it at Via S. Giovanni Bosco 6 in Rovereto.

Upon arrival, I found the Anagrafe Sanitaria in the Segreteria’s office on the left hand side. It’s good that I came right as they opened because the line grew very quickly behind me. Once I got to the window, the lady asked me for my documents:

  • passport
  • permesso di soggiorno (stay permit)
  • proof of payment of health insurance (long top of a paper from the post office)
  • codice fiscale
  • iscrizione (proof of university enrollment)
  • the name of a local general practitioner doctor that will become your main doctor (if you don’t know one, I think they provide you with some options, but it’s better to find someone who speaks English ahead of time)

I had to scramble for some of the items, but since I have taken to carrying all of my documents to every government office every time, I ended up having everything with me. As for the name of the doctor, I got that from a friend who had been to one that apparently speaks English. I have never been there before, so I hope that when I have to go for my thyroxine medication, it all goes smoothly.

However, as the lady started to look up my information from the codice fiscale, something went wrong with her system. She started talking to her colleague, who pulled in another colleague, and another, and soon, everyone was all in a flurry, trying to help this lady figure out her system. I didn’t fully understand what was going on, but apparently the problem had to do with the fact that I was born in the Soviet Union (before its collapse), but my passport and documents all say I was born in Russia. Somehow, this impeded the creation of some sort of internal code or something like that. A frustrating 15 minutes later, they had finally figured out how to reconcile the difference. They gave me a certificate confirming my enrollment and a paper with the doctor’s hours, and I was done. However, because of this slowdown, I missed my last train to work before the 2 hour break in trains.

I would like to point out that it has been 5 months out of the 12 that I intend to stay here, and I am only now finishing some of this process for myself, and I still have follow ups to do with my husband. By the way, my permesso di soggiorno was actually expedited so 5 months should actually be considered faster than normal.

Officialization 10: Leaving Germany

My first year in the LCT master is over, and I am moving from Germany to Italy to do my second year. But damn German bureaucracy… even leaving Germany isn’t easy. Having to talk to all of these offices is like knocking on a door that will never open. Their hours of operation are haphazard, and even when you get through, you just end up asking the same things over and over, hoping someone will know the answer.

Of course, the first thing I had to leave Saarland is to write a physical letter to my landlords announcing my intent to leave well ahead of time (a friend helped me with the correct wording for this). I was lucky and had to do it just one month in advance since many leases ask for up to three months notice. I ended up owing my landlords €140 for electricity over the included amount and a cleaning fee. My lease agreement covered that so it wasn’t a big surprise, but still a bit much.

Next, I needed to go back to the Bürgeramt at most one week before I was to move in order to announce to them that I’m moving and to get a leaving certificate. They needed to see my passport for this. I guess I could have done it via email, but I ended up having time in person. Anyway, it took like half an hour, so just another small annoyance.

The worst part though, is dealing with the health insurance. So, remember when I signed up for national health insurance when I first got here? Yea, it turns out, that was probably a mistake, after all.

Here’s a thing. As a student under 30 in a German university, you are required, by law, to be covered by insurance. You can waive this requirement when you enroll. Although I had a private travel insurance through my program, I chose to actually sign up for the national system anyway, thinking that that would ensure proper coverage through some of the issues that I have. The cost was around €90 a month, and as an American (our insurance system is famously fucked up), this seemed to be quite affordable.

But now that I am moving to Italy, I would like to sign up for the Italian one to make sure I am correctly covered there. My German one is supposed to work in Italy, but I’m told the local one will still probably make more sense to doctors. More to the point though, the Italian one is much much cheaper. It costs less than €200 per year. So that means if I cancel my German insurance and pick up the Italian one, I save something like €900.

But cancelling is harder than it sounds. As I said, there’s a law that requires you to have insurance as a student under 30. Because I signed up for AOK (the national health insurance) when I enrolled, and did not sign a waiver to cancel it, I cannot legally drop it until I am no longer enrolled, and I can’t just change to a private insurance either. Also, I can’t easily un-enroll, because my program automatically re-enrolls me and waives the enrollment fee, since I have to be enrolled in order to submit my master’s thesis work next year.

It sounds like the way for me to drop AOK would be to:

  1. Officially un-enroll in Saarland
  2. Provide proof from the Bürgeramt that I have moved away, and proof of un-enrollment to AOK to cancel my insurance
  3. Get a new acceptance certificate from my department for the second year
  4. Re-enroll with my same matriculation number in Saarland,
  5. Provide proof of a German health insurance again, or a waiver for the insurance

The good news is that since I literally just turned 30, I don’t actually have to do that very last step anymore, since that law only applies to people under 30.

The annoying thing is that after living here for a year, and seeing how things went, I actually think it would have been fine for me to just stick with the private insurance that LCT provided us, and soak whatever costs from the doctors visits would have been. I think it would have been more affordable and easier in the end.

I don’t have time anymore to deal with all of this in person because I am moving to Italy today, so I’ll have to keep following up online.

UPDATE:

Actually, it turns out that since I turned 30, AOK is actually supposed to automatically cancel my insurance by September 30th. Normally, this would be a bad thing, since I think would have to re-sign up with them as a non-student or else get private insurance, which would both be more expensive.

In this case though, it seems like this is a good thing, since all I will have to do now is get the Italian insurance and send it to AOK to confirm that I have something, as I believe is legally required.

All packed and ready to go!