Health insurance must advise on suspected treatment errors

Suspected treatment errors: health insurance must advise insured

A treatment based on obsolete knowledge or even therapies that worsened the health of the patient: Unfortunately, medical errors are not uncommon. If patients suspect that they have not been properly treated by a doctor, they should contact their health insurance provider, because the statutory health insurance funds are obliged to advise their insured in such cases.
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Medical errors are not uncommon
The panels of experts and arbitration boards of the medical associations have recently confirmed around 2,250 medical errors in 2014. Many experts see it as a big problem that the burden of proof usually lies with the patient. Several experts have therefore recently informed about important tips and help with treatment errors. Patients who suspect that they have been mistreated by a doctor should contact their health insurance provider.

Those affected should contact their health insurance
The statutory funds in Germany are obliged to advise their insured in such a case. As the news agency dpa reports, the consumer center North Rhine-Westphalia has pointed out that the health insurance also help to get compensation for pain, if the allegations are justified. However, the prerequisite for this is that the treatment error has arisen as part of a cash payment. The message from the agency explains the steps that should be taken by those involved:

Advice and assessment
According to consumer advocates, the health insurance company advises in person, by phone or even anonymously. The insured should best describe their case and complaints in as much detail as possible. Employees of the health insurance will also clarify the rights of the patient in the conversation. On the basis of internal information, the health insurance then checks whether a treatment error is possible. An indication can be, for example, if a patient has been transferred to a specialist clinic after a routine operation. It is possible for the health fund to obtain treatment documents from doctors and hospitals and to have examination findings and x-rays taken. For this, the affected insured must release the doctors from confidentiality. In addition, the health fund may ask the patient to make a written memory record.

Expertise as a technical basis for legal clarification
If a suspicion is confirmed, the Medical Service (MDK) is added. This will be commissioned by the fund to prepare a report that will be the technical basis for a court hearing or out of court settlement. The person concerned should then demand a written statement from his cashier. And even if he is not offered by him a detailed report. Among other things, the statement should state what facts are available, why there is no maladministration in the case of a negative decision in the report, or why a continuation of the request is discouraged. If there are any further questions, the Consumer Advice Center recommends that you have a final discussion with the responsible health insurance employee. If the health insurance company identifies a medical error as a result of its internal examination and the MDK report, the person concerned should seek a specialist lawyer for medical law. He will enforce the claims for damages and make sure that the limitation periods are taken into account. (Ad)