A neurological examination prescribed as “short” and scheduled after two months, an MRI which should be performed within a few weeks but for which the first available place arrives much later, or a diagnostic test for which the CUP proposes a date incompatible with the priority indicated by the doctor: it is a situation in which many Italians find themselves and which often seems to leave only two alternatives, wait or go to the private sector and pay out of pocket.
In reality, there is a third path, foreseen by the law and linked precisely to respecting the maximum waiting list times, which allows the citizen to ask the Health Service to activate an alternative path when the service cannot be guaranteed within the deadline set by the prescription. Depending on the regional and corporate organization, the solution can be found in another public structure, in an accredited private structure or, in the foreseen cases, in the intramural freelance activity, the so-called intramoenia, with the patient called upon to bear only the possible copay that he would have paid through the Health Service.
However, it is precisely here that the most dangerous misunderstanding arises: it does not mean that those who find a waiting list that is too long can independently choose a private specialist, pay the invoice and subsequently request reimbursement from the local health authority. The path must be activated through the healthcare system and according to the procedures established by your Region or healthcare company.
The times that the Health Service must respect
The starting point is the letter indicated on the medical prescription, because for first-time specialist outpatient services the doctor must specify the diagnostic question and the priority class, which establishes within how long that visit or exam should be carried out.
The class Uurgent, requires that the service be performed within 72 hours; the class Bshort, within 10 days; the class Ddeferrable, within 30 days when it concerns a specialist visit and 60 days when it concerns a diagnostic test; the class Pprogrammable, generally has a maximum term of 120 days.
These are therefore not simply letters used to organize hospital diaries, because behind each class there is a clinical evaluation by the doctor on the speed with which it is necessary to carry out a specific test. If a priority B visit is proposed after two or three months, the problem is not just that the wait seems long: it is that the proposed date does not respect the time associated with the assigned priority.
What to do when the CUP proposes a date that is too far away
The first step remains the booking through the CUP or through the other channels made available by the Regional Health Service. The citizen must verify whether there is availability compatible with his/her priority class in the territorial guarantee area provided by the Region, keeping in mind that the right concerns above all access to the service within the correct timeframe and not necessarily the possibility of choosing a specific hospital or a specific doctor.
If the system does not find any compatible appointment, it is important not to simply abandon the search and immediately contact the private individual, but to ask how to activate the so-called protection path foreseen for failure to respect the waiting times.
The operating procedures are not identical throughout Italy: depending on the Region or the healthcare company, it may be necessary to contact the CUP, the URP, the healthcare management or an office specifically responsible for managing waiting lists. Precisely for this reason it is advisable to keep the prescription and all the documentation relating to the booking attempt, including the proposed date or any communication of the absence of availability.
The request serves to formally enable the healthcare company to seek an alternative solution compatible with the priority indicated on the prescription.
When you can get to intramoenia by just paying the ticket
The regulatory basis for this protection did not arise today. Article 3, paragraph 13, of Legislative Decree 124 of 1998 provides, under certain conditions, that when the wait exceeds the established deadlines, the patient can request that the service be provided within the scope of the intramural freelance activity, causing the difference between the actual cost of the service and the participation in the expense owed by the citizen to be passed on to the healthcare system.
In other words, when the path is correctly activated and the foreseen conditions are met, the patient can receive an intramoenia service by only paying the possible co-payment provided by the Health Service. If he is exempt from the ticket, this mechanism also takes the exemption into account.
However, intramoenia is only one of the possible solutions. Even before that, the healthcare company can find an appointment in another public facility or at an accredited private provider, as long as the service is guaranteed within the expected time frame.
The waiting list system was also strengthened by Legislative Decree 73 of 2024, then converted into Law 107 of 2024, which introduced new national control and monitoring tools, including the National Waiting List Platform at Agenas, with the aim of verifying availability of agendas, actual times and compliance with priority classes.
The mistake not to make: book privately yourself
It is probably the most important point, because it is also the one on which a title like “private visits by paying only the ticket” risks generating the most confusion.
Overcoming waiting times does not automatically give you the right to book a private visit on your own initiative and have the invoice subsequently reimbursed by the local health authority. The legislation protects the patient’s right to obtain the service within the expected time frame, but the alternative solution must be managed or authorized according to the path established by the competent healthcare company.
Therefore, if the CUP proposes a visit beyond the limit of its priority class, the correct step is not to telephone the specialist’s private practice directly, but to report the impossibility of obtaining the service within the expected timeframe and formally request the activation of the protection process.
A detail that is anything but secondary, because a private visit purchased independently is normally paid by the patient and the simple fact that the public waiting list was too long does not automatically transform that expense into a credit towards the Health Service.
The right concerns the time of treatment, not the doctor you prefer
Finally, there is another element to know before activating the procedure. If the healthcare company identifies an alternative structure capable of guaranteeing the service on time, the citizen cannot necessarily claim to maintain his preference for a specific hospital, clinic or specialist and at the same time claim protection over waiting times.
The principle underlying the system is in fact to guarantee timely access to the necessary service, not the free choice of any doctor or structure at the expense of the Health Service.
For those who find themselves faced with a waiting list incompatible with the prescription, therefore, the steps to remember are simple but decisive: check the priority class shown on the prescription, attempt to book through the CUP, document any impossibility of obtaining a date within the deadline and ask the health company how to activate the protection process.
Because between waiting many months and paying hundreds of euros out of pocket there may be another possibility. The problem is that, even today, many patients don’t know they can ask for it.
