Is the assumption of costs for medical treatment refused? If coverage for a treatment has been refused on the grounds of lack of medical necessity, the burden of proof lies with the insured person. Accordingly, the patient who wishes to claim a certain service must prove that it is medically necessary.
How long has the application for cost coverage been approved? If the statutory health insurance fund does not decide within three weeks on an application for the assumption of costs for medical treatment, this is deemed to have been approved. The health insurance fund cannot subsequently revoke the approval. If an expert opinion from the MDK is required, the deadline is five weeks.
Has the application for cost coverage been rejected? It often happens that the first application for cost coverage is rejected by the health insurance company. As a consequence, an objection can be filed immediately. However, a four-week deadline must be observed.
Can the insurer substantiate the cost of medical treatment? If the insurer can prove that the costs of medical treatment are not reasonable, it may reduce them to a reasonable amount. However, in order to do so, it must prove that there was no medical necessity for the treatment, at least in part.
What are the most important requirements for cost coverage by the health insurance? The most important prerequisites that must be fulfilled in order to have any chance at all of having the costs covered by the health insurance company include, first and foremost, a detailed written statement by the policyholder as well as a report of the findings on the course of the disease or illness described in a well-founded manner by the attending physician.
What is a health insurance reimbursement claim?
As a rule, there is no entitlement to reimbursement for costs incurred prior to the health insurance company's decision on the application for reimbursement. However, many reimbursement therapists offer a free initial consultation. The psychotherapist must inform the patient about this before starting treatment.
How can the health insurance company deny a claim for reimbursement by the insured person?
Par. 4 provides for a claim for reimbursement of costs by the insured person in accordance with Section 37(4) if the health insurance fund cannot provide home help or there is reason to refrain from doing so.
How does private health insurance deny the cost of treatment?
Private health insurance sometimes refuses to cover the cost of treatment, e.g. if it does not see a medical necessity. Avoid this by checking whether the formalities of the invoice are fulfilled and by reading the insurance conditions carefully.
What is the rejection of private health insurance? Private health insurers like to justify their refusal to reimburse submitted invoices with a very general clause according to which costs for treatment are only to be reimbursed in the case of so-called medical necessity. And this is where the confusion begins:
Why are private physicians not covered by statutory insurance? Unlike most physicians in private practice in Germany, private physicians are not so-called "contract physicians" (formerly: panel physicians): they are not licensed to treat patients with statutory health insurance. The statutory health insurance therefore covers the costs for a
Which health insurance companies must determine the cost of a hearing aid?
Private health insurers must set upper limit. Private health insurers are also generally obliged to cover the costs of hearing aids. The basis for the level of cost coverage is the underlying tariff or insurance contract.
Is the health insurance company responsible for financing the hearing aids? If you have statutory health insurance and your hearing loss has been diagnosed by a doctor, the health insurance company is responsible for financing the hearing aids. Social stigmatization is still a fear of many hearing impaired people, which is absolutely unjustified, especially nowadays.
How much does health insurance pay for a hearing aid?
The statutory health insurance funds cover a maximum of 784.94 euros. If you need a more complex hearing aid from a medical point of view, your health insurance will also pay more. Your health insurance company will also pay the same maximum amount for more expensive devices. You then pay the costs that remain.
Which health insurance company offers the highest subsidy for the purchase of a new hearing aid?
Which statutory health insurance company offers the highest subsidy for the purchase of a new hearing aid? BKK's offer the highest subsidy. Company health insurance funds pay €873.50 for one device and €1,594 for two devices. Cost absorption with Techniker Krankenkasse
How much does Techniker Krankenkasse pay for the hearing aid?
For people with severe hearing loss, Techniker Krankenkasse offers a significantly higher co-payment. Upon presentation of a medical certificate proving the degree of hearing loss, TK pays an additional 841.94 euros for the first hearing aid and 673.55 euros for the second device.
How does the health insurance company regulate the costs for intensive care?
Section 37 of the German Social Code (SGB V) regulates the assumption of costs for intensive care. In principle, your health insurance fund covers all costs for outpatient intensive care.
What are the costs of intensive care in your own home? LEBE cannot give you any exact information about the expected costs of intensive care in your own home. Depending on whether your relative to be cared for has statutory or private insurance or became a ventilator patient as a result of an accident, there are specific regulations for the assumption of costs by health insurance funds or insurance companies.
What does health insurance cover for intensive home care?
Your health insurance will cover the costs of intensive home care even without a nursing degree. A classification can even lead to bureaucratic problems: Some health insurers consider the nursing care insurance fund responsible and refuse to pay.
How much does health insurance pay for a critical care nurse?
This is paid 100% by the health insurance, relatives must make co-payments as in a nursing home. There is also the 1:1 care. Here e.g. 40 euros per hour are set, if the intensive care patient is cared for by 1 intensive care nurse, that is then on the day e.g. 960 euros and x 30 days again.
How is intensive home care regulated?
Entitlement to intensive home care is regulated by Social Code V §37. Basic care services are regulated with the help of the Social Code XI. This includes services such as:
Is it still possible to refuse to cover the costs?
If, nevertheless, a refusal to cover the costs comes, although according to the list of aids / remedies an entitlement exists, affected persons not infrequently have the impression that the insurance companies would reject any application from the outset and hope that the applicants would give up.
How can I establish a claim for coverage? However, there is no legal basis that would justify a claim to the assumption of costs in either case. It is always a discretionary decision. However, those affected who want the job center to assume the costs of a driver's license can refer to Section 16 of the German Social Code II (SGB II).
How can I contact with the assumption of costs? Recipients of unemployment benefit 1 can also contact the employment office responsible for you with a request to have the costs for a driver's license covered. However, there is no legal basis that would justify a claim to the assumption of costs in either case. It is always a discretionary decision.
What is a prerequisite for filing a lawsuit against the denial of coverage? A prerequisite for an action against the refusal of cost coverage is the prior objection to the health insurance fund for those insured by the statutory health insurance. The complaint can then be recorded orally with witnesses at the office of the competent social court.
When can a rejection be raised again?
In the event of a renewed rejection, an action can be brought against the health insurance fund before the social court within one month. A lawyer is not required, so you can represent yourself. In principle, however, legal counsel is advisable.
Why am I appealing the rejection letter? Therefore, I hereby file an appeal against the above-mentioned rejection notice and request that the matter be reconsidered. If you have received a rejection notice and do not agree with this decision, you can usually file an appeal.
Is the application rejected by any authority?
If the application has been rejected by an authority, the decision always specifies the deadlines and forms of appeal (only some district courts sometimes forget this). An application can also be re-submitted at any time, e.g. if other conditions have arisen.
How can I revoke a rejected application?
It makes little sense to revoke a rejected application. If the application has been rejected by an authority, the decision always specifies the deadlines and forms of appeal (only some district courts sometimes forget this). An application can also be re-submitted at any time if, for example, other conditions have arisen.
How often can you file a revocation against the rejection?
If an application is rejected, how often can you file a revocation against the rejection? If you have submitted an application and it is rejected, does it depend on the application form how often you can submit a revocation, or is it the same for every application.