No charge for rhythmic massage

Statutory health insurance companies do not pay for rhythmic massages

04/02/2012

The statutory health insurance companies are not automatically obliged to reimburse alternative treatment methods, even if the remedies of anthroposophic medicine are considered by lawmakers to be „special therapy direction“ be acknowledged. This emerges from a judgment of the Landessozialgericht (LSG) Hessen in Darmstadt, in which the judges had refused a cost for the treatment with so-called "rhythmic massages by the legal health insurance of the plaintiff".

In the verdict, the judges of the LSG explain that the basis for a reimbursement of treatment by the statutory health insurance (SHI) is a positive assessment of the Joint Federal Committee (G-BA). Since this is not yet available for the anthroposophic treatment method of rhythmic massages, the health insurance companies are not obliged to a reimbursement. (AZ: L 8 KR 93/10)

No right to reimbursement for alternative therapies
Although the legislature has been in §2 of the fifth Social Code (SGB V) clearly states that „Treatment methods, medicines and remedies of the special therapy directions“ are not excluded from a reimbursement by the GKV. However, in individual cases no right to reimbursement can be deduced from this, if the applied treatment method has not yet received a positive rating from the G-BA, the Hessian state social court ruled. In the corresponding proceedings, a 77-year-old woman from Marburg had sued her health insurance company because she refused to pay the bills submitted for the patient's rhythmic massages. The treating physician had prescribed the plaintiff the massages for the treatment of her rheumatism illness, in the hope on the basis of the alternative treatment method from the range of the anthroposophic medicine to achieve a relief of the complaints of his patient.

Alternative treatment method of rhythmic massage
The rhythmic massages were developed by the anthroposophic doctor Ita Wegman, who - for the first time in the Ita Wegman Clinic in Switzerland, founded in 1921 - used them for the comprehensive treatment of patients. By combining classic massage methods with the approaches of the anthroposophy developed by Rudolf Steiner, the scope of the rhythmic massages has been significantly expanded compared to conventional massages. For example, Ita Wegmann used her massage method to treat functional disorders of the organs. The aim of the rhythmic massage is primarily to improve the circulation and the tissue fluid movement in the organism and the removal of false voltages in muscle and connective tissue. This should improve, for example, the respiratory and cardiovascular function. According to the users, the rhythmic massages also contribute to the normalization of digestion and to the strengthening of self-healing powers.

Health insurance refuses to pay for rhythmic massage
Despite these well-known health-promoting properties of rhythmic massages and the consideration of alternative treatment methods by the legislature, a reimbursement by the statutory health insurance is not yet mandatory. Thus, the health insurance of the applicant refused reimbursement for the alternative treatment method, on the grounds that this as „new treatment method“ should be assessed, as no classification has yet been made by the G-BA. The fact that rhythmic massages have been used for decades in anthroposophic medicine played no role in the health insurance of the 77-year-old patient. The lady was thus injured in her rights so much that she moved to the Hessian state social court. However, the judges followed the view of the health insurance and decided in their judgment published on Thursday (02 February) that the condition for the reimbursement by the insurance company is a positive evaluation of the treatment method by the Federal Joint Committee. A reimbursement by the health insurance for the rhythmic massage rejected by the LSG judges, since so far there is no positive classification of the treatment method by the G-BA.

Assessment of the rhythmic massage required by the G-BA
In the course of the proceedings, the plaintiff's lawyers had also tried to assert a system failure, which in case of doubt would have resulted in a liability of the health insurance fund. But this was in the opinion of the judges not given, because in addition to the rhythmic massages numerous other treatment method such as classical massages or physiotherapy for the treatment of rheumatic disease of the applicant were available. A system failure can not be seen here, judges ruled. Nevertheless, it remains to be criticized that the G-BA has so far made no assessment of the rhythmic massages and therefore there is no legal certainty in the assumption of costs. For the benefit of patients who would like to take advantage of this alternative treatment method, a timely classification of rhythmic massages would be highly desirable. (Fp)

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Image: Stephanie Hofschlaeger