06.05.2024 – 18:00
rbb – Broadcasting Berlin-Brandenburg
Berlin (ots)
### CORRECTION: Incorrect wording: The 30 percent does not refer to court decisions ###
### SPRRFIST: Monday, May 6th, 2024, 6:00 p.m. ###
SUPER.MARKT: Nursing report: Every third objection successful
The German nursing care funds often wrongly reject contradictions. If the application for the assignment of a care level is rejected, the insured person can file an objection. However, this is often rejected only with general reasons.
This is now proven by research by the rbb consumer magazine SUPER.MARKT. In addition, some nursing care funds apparently systematically try to persuade insured persons to withdraw their objection. However, in 30 percent of cases it turns out that the objection was admissible.
Germans are getting older and older, which is why nursing care funds are also under pressure. According to the Medical Service, around 2.5 million nursing reports were prepared in 2022 alone. In the same period, 185,000 objections had to be processed. However, these are often simply rejected outright.
In the case of a 75-year-old Berlin woman, for example, the BARMER nursing care fund refused to award her a nursing degree. Her objection to this was also rejected, but without specific reasons being given and without a new medical assessment.
The lawyer Florian Specht observes such blanket rejections more often. With his start-up “Pflegewacher” he supports insured people in the event of need for care. The lawyer criticizes: “The fund is legally obliged to list reasons in individual cases why the objection was unsuccessful.” In fact, nursing care funds are required by law to examine a case again in detail – usually through an additional home visit, and only in exceptional cases only based on the files. According to BARMER, that was enough here; When asked by SUPER.MARKT, she said that the case had been examined correctly.
In order to ward off contradictions, nursing care funds sometimes go even further and try to talk insured people out of their plans. The Kaufmännische Krankenkasse (KKH), for example, asked a 70-year-old from Dallgow-Döberitz, who has had three strokes and suffers from chronic pain, in writing whether she wanted to withdraw the objection she had already submitted. Such inquiries are not an isolated case either. “This is actually done institutionally by the nursing care funds,” reports lawyer Florian Specht. “The point here is to try to get the insured person to voluntarily waive their objection.”
However, the expert strongly advises against this. Because appealing against the rejection of a nursing degree can be worth it in the end. The figures from the Medical Service show that around 30 percent of the appeals are ultimately successful – despite the factual situation remaining unchanged.
All details and information on Monday, May 6th. at 8:15 p.m. on rbb and then in the media library: https://ots.de/mrWzZK
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Original content from: rbb – Rundfunk Berlin-Brandenburg, transmitted by news aktuell