Increase in dissatisfaction with private health insurances

More and more private insured are dissatisfied with their health insurance. In 2009, over 5000 claims were received by the PKV Ombudsman.

(03.06.2010) About 15 percent more complaints were received by the PKV Ombudsman last year. Around 5015 disputes had to clarify the Obhudsmann. In most cases, it was not about increased medical fees, but the settlement costs of necessary services by the private health insurance (PKV). For example, a private health insurance company refused to pay the costs of having a baby accompanying their mother during inpatient treatment. The mother had to take the infant to the hospital because the child was still breastfed. Also the PKV of the father refused, because in the opinion of the health insurance the infant would not be in need of treatment. "The reasoning of both insurers was basically correct, but led to an unsatisfactory result," said Obhs. Helmut Müller and still found a good solution: the costs had to share both health insurance.

The times for the health insurance companies are getting worse. This is also reflected in the moral health insurance in the acquisition of costs and goodwill regimes again. Compared to 2008, the number of complaints rose by 15 percent to 5015 cases. According to Dr. Mueller were only 432 complaints. However, the number of complaints received in the comparison of the 30 million PKV insured is still relatively small. According to the PKV arbitration board, the complaint rate is just under one percent. However, many issues are either resolved in court or not. Most citizens are likely to settle for the negative answer. Müller, however, sees the rise not justified by the fact that the private health insurers would have to save. Rather, the increasing awareness of the arbitration board is responsible.

The complaints in the overview: The largest share of the complaints came in because of private health insurance. Here the share was 83 percent. In 2008 it was only 78 percent. About 25 percent of the complaints were successful in the customer's interest. Most of the complaints (22.8 percent) were due to the refusal to provide medical services. Complaints based on the doctors' fees were filed in 13.9 percent of the cases. Because of the general insurance conditions of private health insurers were judged in 10.4% of cases. Complaints due to the new base rate were reported in 3.1 percent and 3.2 percent due to misrepresentations by insurance agents.

Obhudsmänner- and women have the task of avoiding litigation through mediation. However, neither the health insurer nor the insured are bound by the recommendations. Only "recommendations" are pronounced. However, consumers also have the opportunity to file a complaint with the BaFin Financial Supervisory Authority. So 1757 customers complained about their private health insurance. (Sb)

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