As of: March 8, 2024 5:30 p.m
Anyone who is sick or has a disability often needs aids such as walkers, wheelchairs or prostheses. What should insured people consider when the health insurance company covers the costs and when purchasing?
Aids are intended to help people with illnesses or disabilities live pain-free and self-determined lives in everyday life. They are intended to ensure the success of medical treatment, prevent impending disability or compensate for a disability. Well over 30,000 are listed in the so-called resource directory. Medical supply stores or health insurance companies make them available on loan. Health insurance companies can cover the costs.
Prescription required for health insurance to cover costs
In order for the health insurance company to approve an aid and cover the costs, you need a doctor’s prescription – a prescription. The doctor decides which aid is useful and necessary in the situation. There is a so-called aid guideline for this. It is important that the regulation is filled out as precisely as possible. The prescription must indicate medical necessity. If an aid is rejected by the health insurance company, the insured person has the right to file an objection or lawsuit.
How much do insured people have to pay?
Adults must pay a minimum of five and a maximum of ten euros for each aid. For consumable aids – such as incontinence aids – it is a maximum of ten euros per month.
Keep invoices safe
If all additional payments in the year exceed two percent of the annual gross income, insured persons can exempt themselves from further additional payments in the calendar year with their health insurance company or have additional payments reimbursed. In the case of serious or chronic illnesses, an exposure limit of one percent applies. The exemption from co-payment is not automatic; it must be applied for. Those affected should therefore keep invoices and receipts in a safe place.
Health insurance models only cover medical needs
The prescribed aids are usually standard versions, for which no additional out-of-pocket costs are required apart from an additional payment of a maximum of ten euros. According to consumer advice centers, these health insurance models are usually sufficient to cover medically necessary needs. However, patients can also opt for an aid that goes beyond what is necessary. This could be, for example, a higher quality version or a model with special functions. These additional costs are often not fully covered by health insurance.
Application rejected: what to do?
If your application for an aid is rejected, you can file an objection within one month. The objection should be submitted in writing and provided with detailed reasons. It makes sense to include a medical statement. The applicant’s particular situation and problems should also be highlighted. It is advisable to seek expert support, such as that offered by consumer advice centers and social associations (SoVD, VdK). Experience shows that contradictions are often worthwhile. According to its own information, the SoVD Lower Saxony has a success rate of 50 percent in its appeal proceedings.
If the reimbursement of costs continues to be refused, a lawsuit can be brought before the social court within one month.
Make sure you get good advice from a medical supply store
Medical supply stores are legally obliged to always provide information about additional cost-free health insurance models during the consultation. Consumers should always ask and test them. Before concluding the contract, the consultation protocol or the contract should be read carefully. A return or exchange is usually not possible for most aids. The consumer advice center therefore advises against impulse purchases. Every purchase from a medical supply store should be carefully considered because if you have any doubts, you will be left with the product.
Order aids online
Aids can also be ordered online, but this is not always advisable: If individual adjustments need to be made, the Social Association of Germany recommends purchasing them from a stationary medical supply store because individual advice is available there. However, non-prescription items such as shower stools or blood pressure monitors can be cheaper online than in stores. It can also make sense to order online if you need aids such as incontinence items because you often get a price advantage or discount.
In addition to health insurance, other payers are also possible
When it comes to covering the costs of an aid, several cost bearers come into consideration. Statutory or private health insurance is usually the right address. Depending on the purpose or reason for which the aid is needed, the pension insurance, accident insurance, the employment agency or the social welfare office can also cover the costs.
What is the difference to nursing aids?
Nursing aids are granted by the statutory nursing insurance. The prerequisite for this is that the person affected is in need of care and has a level of care. Nursing aids are devices and materials that are necessary for home care. They are intended to make care easier and help to alleviate symptoms or enable those in need of care to lead a more independent life.
Deadlines for collecting supplies
You can usually keep smaller aids such as stockings, bandages or orthoses. The situation is different with larger items such as beds, wheelchairs or oxygen devices. They are usually only borrowed and remain in the possession of the health insurance companies or medical supply stores. They are usually obliged to pick up the aids again. There is no legally specified deadline for this, but it usually takes a maximum of 2-3 weeks, says Klaus Wicher from SoVD Hamburg. Aids may not be disposed of or resold. This could lead to claims for damages.
Further information
If statutory health insurance companies reject a requested service, insured persons can lodge an objection. Those affected can get help from numerous independent advice centers. more
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Anyone who can no longer cope with everyday life alone can receive benefits from long-term care insurance. Tips for applying. more
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Market | Mar 11, 2024 | 8:15 p.m