Health insurance companies have to pay for the electronic foot lift system

LSG Stuttgart sees significant benefits for two MS patients
The statutory health insurance companies must pay insured persons with a nervous disorder of walking an electronically controlled "foot lift system". It depends solely on the benefits for the insured, as the Land Social Court (LSG) Baden- Württemberg in Stuttgart in two on Tuesday, June 26, 2018, decided rulings decided (Az .: L 4 KR 531/17 and L 11 KR 1996/17). A positive recommendation of the joint Federal Committee (G-BA) is not required.

Health insurance companies have to pay. (Image: BillionPhotos.com/fotolia.com)

Thus, the LSG admitted two women, each of whom suffers from multiple sclerosis (MS) about 15 years ago. This is a chronic inflammation that attacks the protective layer of the nerve fibers. Often this affects the nerve impulses to the muscles and thus permanently weaken the muscles. The number of illnesses in Germany is estimated at over 200,000.

The two applicants had their doctors prescribed the electronic foot control system "Ness L300". The device of the US manufacturer Bioness is attached with a cuff on top of the calf. A software analyzes the movements and also the condition of the soil. From this, it calculates electrical impulses that are sent wirelessly to the ankle muscle in the front tibia. The cost in 2015 was 5,500 euros plus additional costs, such as for a briefing. According to the manufacturer, the device is also suitable for other nerve disorders, such as a stroke or spinal cord injury.

For the two MS-ill women, the health insurance companies refused to pay for the equipment. They referred to conventional aids such as bandages and orthoses. For the electronic foot lift system "Ness L300", there is still no positive recommendation from the G-BA. This body, made up of physicians and health insurance companies, decides which treatment methods the statutory health insurance companies pay for.

But here the device "does not serve the actual medical treatment, but has as a tool for immediate disability compensation the goal to improve mobility and mobility," now emphasized the LSG Stuttgart. For this a positive decision of the G-BA is not required. Also insured persons would not have to refer to less expensive but less effective aids. Rather, there is a "claim to the greatest possible compensation of the functional deficit, taking into account the current state of medical and technical progress".

With judgment of 15 June 2018, the 4th and on 19 June 2018, the 11th Senate of the LSG Stuttgart was convinced that "the new foot lift system brings significant improvements for the mobility and mobility of the insured and thus the supply necessary and justified ". Both Senate relied on video documentation, which had already been commissioned by the health insurance in the first case and by the LSG in the second. mwo / fle