Thirty questions that Irish patients and their families ask, with our answers checked against the rules the Health Service Executive (HSE) publishes. Ablement is not part of the HSE; the official rules are on its website. If your question is not here, ask us in the chat or schedule a free call.
No. The rules do not ask you to be on a waiting list, or to have waited any length of time. What you need is a referral letter from your GP (general practitioner), or from a consultant you saw as a public patient. A letter confirming that you are on a public waiting list for the same treatment is accepted in place of the referral letter, but it is not required. You must also be entitled to the treatment as a public patient in Ireland.
You can use it if you have lived in Ireland for a year, or intend to live here for at least a year, and you are entitled to the treatment as a public patient in Ireland. You must also see a consultant as an outpatient before the treatment. You do not need a medical card, and having private health insurance does not rule you out. If you live in Ireland on a visa scheme you cannot apply, and if you are paid a pension or income from another country different rules may apply; see the question on pensions below. The treatment must be one the public system in Ireland provides.
Yes. You need a referral letter from your GP, or from a consultant you saw as a public patient. A referral you got as a private patient cannot be used. The letter must give your name, address and date of birth, the name and address of the hospital or service and the specialty, a summary of your condition and the reason for the referral, and it must be signed unless it is an electronic referral. The date matters: the letter must be dated before your outpatient consultation. Claims have been refused over mistakes in these letters, so we check your letter with you before you book anything.
Many GPs know the scheme, but not all. The HSE runs it, and its Cross Border Directive office in Kilkenny answers questions from patients and doctors on 056 778 4546. The decision to refer is your doctor's; a doctor is not obliged to refer a patient abroad. The letter is addressed to the specialty, for example 'to the consultant orthopaedic surgeon', and the HSE's rules also ask for the name and address of a hospital or service; the Ombudsman has said a letter addressed to the specialty must not be refused, and the HSE agreed. We tell you what the letter must say before you ask for it.
Yes. Having private health insurance does not exclude you. But you cannot use a private referral: the referral must come from your GP or from a consultant you saw as a public patient. Your claim will not succeed if your insurer pays for any part of the treatment, so do not claim on your insurance for anything to do with it. The scheme covers planned treatment only, you pay first, and the refund stops at the Irish public rate.
It can, so check before you book anything. If you are paid income or a State pension from another country in the European Union or the European Economic Area, you may have to apply through that country and not through Ireland. If your pension or income comes from the United Kingdom or Switzerland, you may not be eligible at all. The HSE asks people in this position to contact its office, which will say whether you are eligible. We ask you about this in our first conversation, before anything else happens.
Yes, you must have an outpatient consultation before the treatment: abroad with the consultant who will treat you, or in Ireland with a consultant who sees you as a public patient. If you will stay overnight in hospital, the HSE says the consultation must be in person; it can take place at the hospital before you are admitted. If it is a day case, it can be in person, by telephone or by video call. Your referral letter must be dated before the consultation. We tell you which applies to your treatment.
There is no fixed list. As a general rule, if a treatment is available in the public system in Ireland, you can be referred for the same treatment abroad. Hip replacements and cataract surgery are among the examples the HSE gives. Not covered: organ transplants, long-term care such as nursing home care, vaccination, and treatment that is not for medical reasons. The treatment must be in a country of the European Union, or in Iceland, Liechtenstein or Norway. The United Kingdom is no longer included. Ablement arranges planned surgery in Spain.
The choice is yours, with your doctor. The HSE does not recommend or approve hospitals abroad. The hospital can be public or private; it must be a recognised hospital, and the doctor who treats you must be registered. By law, a hospital in another European Union country must give you clear information on its prices, its registration and its insurance cover. We propose one hospital in Spain for your treatment and give you that information in writing, so that you and your doctor can decide.
Not under this scheme. Since the United Kingdom left the European Union, the Cross Border Directive no longer covers Northern Ireland. There is a separate scheme, the Northern Ireland Planned Healthcare Scheme, for treatment with a private provider in Northern Ireland; the HSE describes it as similar. Ablement arranges treatment in Spain only.
No. They are three different things. The Cross Border Directive is for planned treatment that is available publicly in Ireland: your GP can refer you, you pay the hospital, and you claim the cost back afterwards. The Treatment Abroad Scheme is for treatment that is not available in Ireland; only a public hospital consultant can refer you, and approval comes before you travel. The European Health Insurance Card is only for necessary or emergency care while you are abroad. Ablement is a private company and not part of the HSE.
Nobody can promise that in advance. The HSE decides your claim after the treatment, when it has your documents. Whether you get everything back depends on two things: that the hospital's price is no higher than the Irish public rate for your treatment, and that your paperwork meets the rules: the referral letter, the consultation, and proof that you paid the hospital yourself. We go through each of these points with you before you pay anything. You can also ask the HSE beforehand; this is called prior notification, it is optional, and it tells you whether you are eligible and roughly how much you might get, not the exact amount.
The HSE pays the refund in 45 days, on average (2024). The clock starts only when every document is in. We send your claim within five working days of your return home and follow it up until it is decided.
You get back whichever is smaller: what you paid the hospital abroad, or what the same treatment costs in the public system in Ireland. The Irish cost comes from a published price list, with one price for each type of treatment, and it depends on whether the treatment would be done in Ireland as a day case or with an overnight stay. The prices are reviewed every year. We tell you in writing which price applies to your treatment before you decide. The final figure is set by the HSE after your treatment.
Then you pay the difference yourself; the HSE says plainly that you are responsible for any shortfall. We look for a hospital whose fixed price is below the Irish public rate for your treatment. If no hospital offers one, we tell you and show you the gap in writing, and you decide. The Irish rates change from time to time, so the comparison is made on the rates in force when you are treated.
You pay the hospital, not us, and you pay before you are paid back. When depends on the hospital's own terms: some hospitals ask for payment before treatment, some for a deposit first and the balance later. Your written proposal says exactly when and how, before you commit to anything. The payment must come from an account in your own name, with a receipt in your name, because the HSE asks for proof that you paid the hospital yourself. If a family member wants to help with the cost, they should transfer the money to you first. If you cannot pay first, some people use savings, help from family or a loan from their local credit union; interest on a loan is not part of the refund. Ablement does not lend money and never handles your payment.
No. The HSE says the scheme does not cover other costs such as travel, accommodation or translation. You pay for flights, the hotel before and after your hospital stay, transfers and meals outside the hospital. The hospital's invoice must list the treatment charges separately; claims have been refused where one total mixed treatment with travel or accommodation. We check that the invoice is in the right form before you fly home.
Yes, you can bring someone. Their flights, hotel and meals are your own cost; the scheme covers only your treatment. Whether you need someone with you depends on the operation and on what the hospital advises for the journey home; ask the surgeon at your consultation. The Consent Form asks whether an adult can travel with you and stay with you after the treatment. If a hospital's price includes a companion's stay, that part cannot be claimed back.
The claim is yours: you sign it, and the refund is paid to you. The doctor who treated you abroad must complete and sign one section, in English. With the form go your referral letter, the hospital's itemised invoice and proof that you paid the hospital yourself. We fill in the form, collect the hospital's section, check every document and send the pack to the HSE; you sign the declaration. The form contains personal and medical details, so we handle it only through our secure tool, as our privacy notice explains.
You can appeal within three months of the decision, by post or e-mail, to the National Appeals Service of the HSE. If you are still not satisfied, you can complain to the Office of the Ombudsman. We draft the appeal for you, free of charge; you sign and send it. The reasons the Ombudsman found most often were a problem with the referral letter, the timing or form of the outpatient consultation, proof of payment, and a pension from another country. We check all four with you before you pay anything. We cannot cover a shortfall.
While you are in Spain, the hospital that operated on you looks after you. Before you pay, your written proposal tells you in the hospital's own words what its price covers if you need to stay longer or need more treatment. If you are harmed by the treatment, the law of Spain applies; the hospital must have a complaints procedure and liability insurance. Once you are home, go to your GP, or to an emergency department if it is urgent; you are entitled to the same follow-up as if you had been treated in Ireland. Ablement is not a hospital and carries no responsibility for your medical care, but we are easy to reach and we help you deal with the hospital.
Your GP. After your treatment abroad, your GP can refer you for any follow-up care you need in the public health system in Ireland. Follow-up such as physiotherapy is arranged in the usual way and may involve a wait, so speak to your GP about it before you travel. We ask the hospital for a discharge report in English for your GP, and we check that you have it before you fly home.
It depends on the hospital, so it is one of the things we settle before we propose one. The hospital gives you an English-speaking liaison as your first contact in Spain. We tell you in writing what English-language support the hospital provides: at the consultation, on the ward and in your discharge papers. The scheme does not pay for interpreters, and any document in another language needs a certified translation for your claim, so we ask the hospital for its documents in English.
Every operation carries risk, at home or abroad; your surgeon explains the risks of yours at the consultation. A hospital in Spain works under Spanish law and Spanish standards of quality and safety. The HSE does not approve hospitals abroad, and we do not claim that it does. You are entitled to ask the hospital about its registration and its insurance, who the surgeon is, how many of these operations they do in a year, and what happens if you need to stay longer. We give you the hospital's answers in writing before you decide.
It depends on four things: how soon you get your referral letter, when the hospital can offer a consultation and a date, any tests the surgeon asks for, and when you have the money ready. Once your file is complete, you receive our written proposal within five working days, and once you accept, the hospital confirms your date in writing. If you choose to ask the HSE for prior notification first, allow for that too. How long you stay in Spain depends on your operation and on when the surgeon says you are fit to travel home. We give you the hospital's dates in writing as soon as we have them.
It depends on your health and on the operation. Whether you are fit to fly out, and when you are fit to fly home, are questions for your GP and the surgeon. We set out the whole journey for you in writing before you decide, including who meets you and where, so that you or your family can judge whether it is manageable. We suggest a hotel near the hospital and send you a one-page trip sheet before you travel. The flights, the hotel and the transfers are yours to book and pay for, and so are a companion's. Airlines offer free assistance at the airport if you walk with difficulty; it must be booked in advance.
It is legal. It is a right under European Union law since 2011, and in Ireland the scheme is run by the HSE itself. It is not free money, though. You pay the hospital first. The refund stops at the Irish public rate. Travel and accommodation are not covered. And a claim can be refused if the rules on the referral, the consultation or the payment are not met. That is exactly the paperwork we handle for you.
Yes. In 2024 the HSE received 2,566 claims under the Cross Border Directive, paid back 2,266 of them and refused 119. It does not always go smoothly: in 2023 the Ombudsman found that some patients had been unfairly refused and left in debt, and made recommendations, which the HSE accepted. We tell you in writing what the HSE pays for your treatment before you decide.
Ablement is a private company, Ablement ApS, registered in Denmark. We are not part of the HSE and we are not paid by it. Our service costs you nothing. We are paid a referral fee by the hospital that treats you; the Consent Form says so. You never pay Ablement: you pay the hospital directly, and the HSE pays the refund to you. Hospitals in the European Union must charge patients from other countries on the same scale of fees as their own patients in a comparable situation.
Because the right comes from European Union law. The directive gives you the right to be paid back for treatment in another European Union country. It does not oblige a country to pay private hospitals at home that are outside its public system. The HSE runs the scheme and has said that Ireland is obliged to reimburse people. It does not recommend going abroad and it does not approve particular hospitals or companies; the decision is one for you and your referring doctor. It lists the scheme among the options for people on a waiting list.