Fees and Waiting Times

Outpatient Services

The National Plan for the Management of Waiting Lists (PNGLA) and regional regulations establish the following priority classes for the provision of outpatient services, which the physician must assign based on the patient’s specific clinical condition:

• U (Urgent): urgent services to be performed as soon as possible and, in any case, within 72 hours.
• B (Short): services to be performed within a short time frame: within 10 days.
• D (Deferrable): services that can be deferred: within 30 days for outpatient visits and within 60 days for instrumental services.
• P (Planned): planned services to be performed within 120 days.

Filling in the “priority class” field by the physician is mandatory for all first-access prescriptions. Prescriptions without this indication are considered as requests for a planned service (P).

The waiting time defined by the assigned priority class starts from the moment the appointment request is made.

At MultiMedica Group facilities, outpatient schedules are structured in accordance with PNGLA guidelines and Homogeneous Waiting Groups (RAO), dedicating appointment slots for first visits or first accesses across a mix of priority classes (U/B and D/P).

To meet healthcare demand within the established time frames, outpatient schedules are organized to ensure that appointments for each type of service are distributed according to the same priority classes.

The Operations Management oversees the scheduling of outpatient services, distinguishing first accesses from follow-up visits and ensuring compliance with access priority regulations.
Schedules are monitored monthly by designated staff to verify adherence to the legally mandated maximum waiting times.
If compliance cannot be ensured for certain services, the administrative coordinator will take the necessary corrective actions.

If a patient is unable to attend the appointment on the scheduled date, it is essential to cancel the appointment promptly, preferably at least 72 hours in advance.
This allows another patient to take the available slot and prevents the patient from being charged the co-payment (“ticket”) for services not canceled in time.
The cancellation must be communicated directly to the facility where the appointment was booked.

For first-access services, if the selected facility is unable to guarantee the maximum waiting time indicated on the prescription within the facilities of the Group that fall under the same territorial guarantee area, the facility will verify alternative availability within the territory or, through the RUA (Unified Access System), identify other options for patient management.

Requests to access services in private practice (Libera Professione) with payment of only the applicable co-payment (when due) must be made at the time of booking if the appointment does not meet the prescribed criteria.
Otherwise, if the patient confirms the appointment, no subsequent change requests will be accepted.

The PNGLA also states that if a patient refuses the first available appointment date at the time of booking, they forfeit their right to the waiting time guarantee associated with their assigned priority class.

Furthermore, no refunds are provided for services booked in private practice (Libera Professione) after the service has been rendered.

Hospital Admissions, Day Care Procedures (MAC), and Low-Complexity Surgical Procedures (BIC)

With regard to hospital admissions, MAC (Outpatient Complex Procedures) and BIC (Low-Complexity Surgical Procedures), the physician, at the time of indicating the need for hospitalization, issues the prescription and assigns the patient a clinical priority class, as specified below:

• Class A: Clinical cases that may rapidly worsen to the point of becoming emergencies, or that could seriously compromise the prognosis. Such admissions must be carried out within 30 days, unless otherwise provided by law.

• Class B: Clinical cases presenting intense pain, severe dysfunction, or significant disability, but with no tendency to worsen rapidly or cause serious harm to the prognosis due to waiting time. These admissions must be carried out within 60 days, unless otherwise provided by law.

• Class C: Clinical cases presenting mild pain, dysfunction, or disability, with no tendency to worsen and without risk of serious harm to the prognosis due to waiting time. These admissions must be carried out within 180 days, unless otherwise provided by law.

• Class D: Clinical cases that do not cause pain, dysfunction, or disability. These admissions must be carried out within 12 months, unless otherwise provided by law.

Patients are then entered into the waiting list using the hospital’s dedicated software. The criteria used to determine the order of admission are, in the following sequence:

1. Clinical or socio-health priority code (A, B, C, D)
2. Order of entry by date
3. Completion of diagnostic assessments and current health status at the time of admission

The waiting period defined by the assigned priority class begins when the diagnostic-therapeutic process shared with the patient has been completed and the physician formally indicates the service (hospitalization notice), unless the patient requests a postponement for personal reasons.

The monitoring of waiting times for outpatient services—both first visits and diagnostic/instrumental examinations—as well as for surgical admissions is carried out on a monthly basis, in accordance with the technical guidelines issued by the Directorate-General for Welfare of the Lombardy Region for the monitoring of waiting times for outpatient services and hospital admissions.

The data collected through monitoring are entered into the SMAF portal, where all local healthcare entities submit the information flows required by the Lombardy Region.

In the Transparent Administration section, there is a dedicated area on Waiting Lists where data on waiting times for MultiMedica Group facilities are published.

Further Useful Information

For additional details and further information, you can consult the institutional portals listed below:

• the website of the Lombardy Region, where the Regional Plan for the Management of Waiting Lists (PRGLA) is available among the published documents

• the websites of ATS Milano, ATS Insubria, and ATS Brianza, where the Corporate Implementation Plans (PAA) are available among the documents

To book an outpatient service through the National Health Service (SSN), you can use the MultiMedica booking services or the Lombardy Region booking services.