Patient transport When does the health insurance fund pay

Health insurance does not always take the transport to the clinic

04/03/2014

Accidents, a sudden serious illness or an old lady who sits in a wheelchair and does not come to the doctor on her own: In an emergency, transport to the doctor's office or clinic can be necessary quickly. However, the costs of transporting the patient are not always borne by the health insurances; instead, patients often have to take care of them - at least proportionately.

Ride must be medically necessary
Whether by taxi, a private ambulance or the ambulance - who needs to be transported to the clinic or to a doctor, can not automatically assume that the costs are covered by the statutory health insurance. Instead, they pay only in certain cases: „Basically, the journey must be related to medical care and must be mandatory“, explains Ann Marini from the GKV-Spitzenverband in Berlin to the news agency „dpa“. According to Ann Marini, which conditions would have to be exactly met for a reimbursement of costs would be regulated by Article 60 of the Social Security Code (SGB) V. Accordingly, a patient transport „for compelling medical reasons“ In each case taken over by the coffers, which vehicle can be used for it, according to the law according to the medical need in the individual case.

Cashiers may also pay for trips to outpatient treatment
The coffers would come to Ann Marini but not only for transport in an emergency, but would provide under certain conditions, other benefits. This would include, inter alia, the transfer to another hospital, if this „necessary for compelling medical reasons“ or if, after consultation with the health insurance fund, a transfer to a hospital close to the place of residence makes sense. In addition, the coffers would, according to the „§ 60 driving costs“ combined with § 115a or § 115b also assume the costs of pre- and post-inpatient treatment or outpatient surgery - provided that this can be used to avoid or shorten inpatient or semi-stationary treatment in the hospital.

Special regulations for severely handicapped or dependent patients
Under certain conditions, the health insurance would also come on trips for further outpatient treatment, but only after prior approval, so the expert from the GKV-Spitzenverband further towards the dpa. For example, according to Ann Marini, dialysis treatments, but also oncological radiation and chemotherapy would be included. In addition, there would be special rules for severely handicapped or dependent patients, for example, after § 53 para. 1 to 3 SGB IX travel and medical expenses in connection with medical rehabilitation measures would be paid.

Co-payments for trips to outpatient treatment
Without „compelling medical reasons“ However, it is not entirely free to transport ambulances to outpatient treatment, as affected persons must be referred to Section 61 („co-payments“) pay up to five euros, no matter what the mode of transport was used. Accordingly, it can be summarized: If there is no medical need, then the statutory health insurance after § 60 SGB V is not obliged to cover the costs for a patient transport. Even those who get sick abroad or have an accident can not automatically rely on the support of their health insurance, because after § 60 (4), the costs of repatriation to the domestic market are not covered. (No)

Image: W. Broemme