Kassen External counselors for the mentally ill

Kassen set because of expensive sick pay on external counselors for the mentally ill

20/10/2013

Health insurance companies are increasingly using external consultants for the care of the mentally ill. Doctors and privacy advocates see problems in this new business model.

Discussions with external consultants are voluntary
More and more frequently, sick employees receive a letter from their health insurance with an invitation to one „Consultation talk on health management“, which should not take place at the cash desk itself but at a private service provider such as Ge.on Case Management. The deliberations of such companies, which are commissioned by the coffers to mentally and chronically ill care, are voluntary. Even if no insured person can be obligated by his cash register to carry out these talks, not many people refuse. According to the head of Ge.on Case Management, Susanne Jacobs-Finkelmeier, this is only a minority: „90 percent of the insured people mentioned by the fund join in and are grateful for our offer.“ Annually, the company cares for around 10,000 people and, according to Jacobs-Finkelmeier, only a few are initially suspicious and would then be persuaded and stay.

Cash registers want to get rid of disabled and chronically ill people
In recent weeks, the handling of health insurance with mentally ill patients was criticized. There was talk of clerks who would exert massive pressure, telephone terror and intimidation. According to a report by the Federal Insurance Office (BVA), attempts were also made to force the disabled and patients with long-term illnesses out of the cash register by telephone. These funds got a clear reprimand. "The procedure described violates fundamental principles of the Social Code and does not meet the responsibility of the statutory health insurance, especially in the medical care of disabled and chronically ill people," complained the authors of the report.

Sick pay should be saved
All this happened against the background of costs. As a rule, sick-lettered employees receive continued payment of remuneration by their employer during the first six weeks and then sickness benefit from the health insurance company. Its height is based on the last salary received. Especially with mental illness it comes often to longer incapacity for work. Stress-induced depression, for example, has increased sharply in recent years and causes many days off. Nationwide, it is estimated that 2.2 million people a year are unable to work because of mental illness. Thus, the number of cases has increased by almost 150 per cent in the last 15 years.

No pressure on the mentally ill
Meanwhile, almost all health insurance funds have discontinued sick pay case managers, in most cases even entire departments are responsible for these particularly costly insured persons. At the same time, a sector of service providers has been established throughout the country, who in some cases have suggested to the health insurance funds that they return mentally ill people back to work and thus get out of sickness benefits. According to Jacobs-Finkelmeier, however, no pressure should be exerted on the insured. „We want patients to get everything they need to get well“, says the company boss. Her staff - psychologists, social workers and doctors - would work closely with the attending physician. „The impression of the layman is: you have to put pressure on the mentally ill, then it will work again“, so the entrepreneur. But with that „ only the opposite is achieved.“

Skepticism about the work of service providers
In addition to the cooperation with the doctors, her company insists on working directly with the patient on his problems. For example, counselors may help resolve workplace conflicts and seek conversation with colleagues or supervisors. However, many doctors and patient advocates are skeptical about the work of these service providers. Claudia Schlund of Independent Patient Counseling (UPD) criticizes: „This creates a subtle pressure on the patients“ and further: „Many feel compelled to strip naked, reveal everything.“ In her experience, many mentally ill people are not free in their decision to talk to the counselors. „They are afraid of the Damocles sword value reduction and therefore participate.“

Data protection worried
For Mrs. Jacobs-Finkelmeier, this criticism is not new, but she considers it unfounded. She would also know the health insurance funds, which would put insured people under pressure and not much interest in their recovery, but their company would not work with them. Another problem that is seen in the work of service providers is data protection. The companies collect a great deal of personal information about the patients and exchange these with the coffers. A spokeswoman for the Federal Data Protection Commissioner Peter Schaar, says that it is still far from clear whether this practice is watertight, even if the insured must agree to this procedure in writing: „There is no legal basis for this.“ She announces a thorough examination: „We will investigate.“ (Ad)