Health insurance companies do not have to pay for telemedicine treatment of infants

Social Court Berlin: Treatment by parents is not recognized
Statutory health insurance funds do not have to pay for a novel videotherapy for home treatment of an infant. The method had to be recognized by the Federal Joint Committee for a reimbursement of a treatment carried out, the Berlin Social Court said in a ruling announced on Wednesday, September 6, 2017 (Ref .: S 81 KR 719/17). Even if an unrecognized method of treatment was successful in the patient, there would be no obligation to pay by the health insurance.

Telemedicine on the rise. Image: Yeko Photo Studio - fotolia

Specifically, it was about an infant from Berlin-Charlottenburg, who was born in September 2015 with a malformation of the esophagus. Several operations were required. The newborn therefore had to be fed for a longer time with the help of a probe. Normal food intake led to strangulation and vomiting.

The mother finally took part in a telemedical probe weaning program developed at the University of Graz. The patient remains at home, the actual probe weaning is performed by the parents. The affected families were cared for by a team of doctors and therapists around the clock. This "netcoaching" included the support of video analysis, daily cyber visits and e-mail counseling.

The costs in the amount of 4,360 euros, however, did not want to take over the Techniker Krankenkasse. Such video therapy is a novel treatment that must have been previously recognized by the Joint Federal Committee. This is a body of physicians, health insurance companies and clinics that decide together on the benefits catalog of the statutory health insurance. Consumer and patient representatives are involved, but have no voting rights.

Without success, the mother argued that her child's telemedicine treatment was not only successful, but also the most cost-effective solution. Alternatively, the child could only have been hospitalized at the clinic.

In its ruling of 11 July 2017, the Social Court ruled that the fund still does not have to pay for the netcoaching treatment. It is a novel treatment method for which the Joint Federal Committee has not yet given its OK.

Although the treatment has the advantage that it can be carried out at home and is also much cheaper than a hospital stay. Disadvantage is, however, that the parents perform the probe withdrawal. Doctors could not examine the patient themselves and therefore not immediately intervene in complications. fle / mwo