The HSE has refused to reimburse people for medical treatment they sought legitimately overseas.
Under a series of schemes patients are entitled to undergo medical treatment abroad and have the costs repaid if the treatment isn't available here or isn't available in a timely manner.
However a report by the Ombudsman has found some patients faced a fight to recoup the costs they incurred, many had to borrow money and others fell into debt.
The HSE says it's committed to implementing recommendations made in the report.
Ombudsman Ger Deering says the HSE's approach was often 'unreasonable and inflexible'.
"Patients in the main, and through no fault of their own, were unable to recoup money that they had legitimately spent on their treatment.
"In some cases, if there was an issue with the initial referral letter that the person received from their GP, if it wasn't properly signed or properly dated - that's not the fault of the patient.
"The real problem was is that there was no way of rectifying that at a later stage when it came to claim."
