Clinic can stay at the cost of emergency aid

LSG Essen: Social welfare office must be informed immediately
If a clinic provides emergency aid for a non-insured patient, it must immediately inform the Social Welfare Office to cover the costs of the treatment. Only if the welfare provider can not be reached, such as on a weekend, the hospital can always reimburse the costs in case of a medical emergency, at least for these treatment days, decided the Landessozialgericht (LSG) North Rhine-Westphalia in Essen in a on 7 September 2016 published judgment (Ref .: L 9 SO 328/14). Only if the welfare office finally gives the cost assurance and the patient is in need of assistance, the clinic can then claim the full case lump sum.

Thus, the plaintiff, a clinic for vascular surgery, remains largely at the cost of an emergency treatment of an uninsured, originating from Kenya patients in the amount of almost 30,000 euros sitting.

Emergency shots are actually meant for emergencies. But far too many patients come there with trivial diseases. (Image: schulzfoto / fotolia.com)

The Kenyan had traveled to Germany for a language course. A German, known to him couple had pledged to bear the cost of living and for the departure. An ADAC Travel Health Insurance has been completed for the man. When the Kenyan met a German, but this rejected his marriage proposal, he jumped in suicidal intent from the third floor of a residential building.

He was seriously injured, including the main artery. The man was admitted to emergency surgery at the Department of Vascular Surgery on December 20, 2009, a Sunday. It was not until Tuesday that the application of the treatment costs by the local social welfare office was requested by fax.

The authority refused. The neediness of the man is not proven. In addition, the hospital had applied for reimbursement on Tuesday and therefore too late. A reimbursement is only possible with prior assurance by the authority. Only in a judicial partial comparison, the social welfare office agreed to pay just under 3,900 euros.

Since the patient, who had since left for Kenya, acted in suicidal intent, travel health insurance also refused to pay. The German couple also did not want to pay, because this would only pay for costs incurred by state authorities.

In its judgment of 18 August 2016, the LSG decided that the clinic could not demand the assumption of the remaining costs of just under € 26,000. According to the LSG, a hospital can, in an emergency, demand the transfer of the treatment costs for an uninsured patient from the social welfare office. The social welfare office must be informed in "reasonable time" about it and approve the reimbursement. This was not the case here.

If there is an emergency case in which the authority can not be informed immediately, as for example on a Sunday, but for this time, even without the consent of the welfare provider, a reimbursement of costs "in due amount" for the treatment can be demanded. According to this, based on the case lump sum, a daily share of the remuneration must be paid by the social welfare office, according to the LSG. The pro rata compensation for the Sunday is covered by the 3,900 euros paid by the welfare office. Without success, the clinic claimed that they had provided the most expensive services on the day of admission of the patient and that they therefore had to be entitled to higher compensation. fle / mwo