Health insurance companies often refuse services

Inadequate health care due to denied health insurance?

08/25/2013

In Germany, patients are increasingly denied help needed. The statutory health insurance funds are more likely to reject services such as sickness benefits, rehab measures or hearing aids. This is clear from figures of the Medical Service of the GKV-Spitzenverband. Even the Federal Minister of Health has now turned on.

Hundreds of thousands of negative opinions
The statutory health insurance companies in Germany deny their about 70 million members more often needed assistance. Hundreds of thousands of health insured persons would have received from their insurance in 2012 a negative decision on benefits such as rehabilitation measures, aids or sick pay, reports the news agency „dpa“ citing current figures from the Medical Service of the Health Insurance (MDK). For example, in 16 percent of all disability-induced disability reviews, experts came to the conclusion that the workers were healthy and could work again. Of the almost 700,000 applications for rehabilitation services reviewed, 39 percent were rejected, and aids and hearing aids produced close to 500,000 opinions, with 37 percent of cases giving negative judgments.

Politics turns on
The Rhineland-Palatinate CDU member of parliament Erwin Rüddel, who represents his group in the health committee of the Berlin Parliament as a reporter for patients 'rights points out that the funds are required by the new patients' rights law to decide on insured applications within three weeks. „If the coffers interpret this provision to the effect that they reject applications 'for the sake of precaution', this would turn the meaning of the law into its opposite. Therefore, we will now take a close look at the practice of the health insurance funds in dealing with the applications of their insured persons“, so Rüddel. Federal Health Minister Daniel Bahr (FDP) has now become active. According to BILD.de he wrote to the Central Association of Statutory Funds (GKV) and to the supreme treasury supervision Federal Insurance Office a strict letter in which he „Examination and opinion“ to the allegations „the rejection of benefits by statutory health insurance“ demand. On August 28, the deadline for an answer ends.

Objection
Experts point out that it may be possible and useful to object to rejected measures. Rüddel also recommends that those affected do not simply accept a possible refusal: „Against this objection can of course be filed, and the attending physician can demand a second opinion. In addition, in such cases, all citizens of the independent patient advice Germany with advice and practical help.“

Mentally ill and frail old woman
However, this is hardly possible for certain patient groups. For example, frail old people and the mentally ill are often at the mercy of the health insurance bureaucracy. For some of these patients is added to the suffering of the disease is that they are confronted with insensitive behavior of the health insurance staff. So it would come to calls to motivate the sick to work again. In addition, workers often conceal mental illness for fear of losing their job or out of shame. For mental illness is still considered a taboo.

Health insurance companies as winners
The winners of these practices are probably the health insurance companies themselves. Thus, any rejected performance improves the balance of the fund. Since 2009, the health insurance companies have been granted a risk structure compensation for particularly cost-intensive patients, but this is no longer available to the mentally ill. This patient group should therefore work as quickly as possible or even leave the cash register. The greater the lack of understanding, even if one takes a look at the cash register. Thus, the statutory health insurance funds in the first quarter of 2013 generated a revenue surplus of 850 million euros. This obviously also among other things because of rejected achievements. Some funds pay premiums to their members, but only to those who would hardly incur any costs anyway.

Doctors increase revenue
While patients are granted less and less help, in addition to the health insurance companies, the doctors also increased their income. This is partly criticized by the coffers. So said the board of the AOK Federal Association, Uwe Deh the magazine „Focus“: „It remains unclear what the insured persons received for an increase in income of 17 percent.“ It was unacceptable that individual doctor groups could increase their income by up to 35 percent while others did not. Another problem that is compounded by rejected health insurance benefits is the principle of self-medication. In pharmacies, for example, every prescription drug sold would now be available for sale. Only ten years ago it was only half as many. Cash patients would therefore not only have to do without a variety of benefits, but also pay their medications more often out of their own pockets. (Ad)

Picture credits: Rainer Sturm