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New judgment No reimbursement of health tourism in Turkey
A man from Lower Saxony, who was treated for borreliosis in Turkey, has to bear the costs himself. According to a recent court ruling, the disease is also treatable in Germany. Therefore, the health insurance does not have to pay for treatment abroad.
Treat illnesses abroad
Although health care in Germany is the best in Europe according to a study, it can be worthwhile in some cases to be treated abroad. So it can sometimes make sense to have certain dental treatments carried out outside Germany, if there the grants are granted by the German health insurance companies. That helps save. However, it is not beneficial to treat diseases in other countries, which can also be treated in Germany. This also shows a current court verdict.
A man from Lower Saxony, who was bitten by a tick years ago, had his Lyme disease symptoms treated in Turkey. A court decided now that the German health insurance does not have to pay for the treatment costs. (Image: Schlegelfotos / fotolia.com) Health insurance refused reimbursement
The Landessozialgericht Niedersachsen-Bremen (LSG) has decided that Lyme disease in Germany is easy to treat. For this it is not necessary to travel to doctors in Turkey.
A 40-year-old, Turkish-born man from the district of Vechta (Lower Saxony), who was bitten by a tick many years ago, had been sued. Shortly before Christmas 2014, he traveled to Turkey, where he had the painful Lyme disease symptoms treated.
After his return in January, he submitted to his health insurance, the AOK - The Health Insurance Fund for Lower Saxony, numerous bills (converted about 860, - €) for reimbursement.
The latter refused to pay because the treatment would have been possible domestically and there had been no emergency.
In addition, the applicant did not request prior approval from the Kester für Auslandsbehandlung.
Lyme disease treatable in Germany
Against this the plaintiff argued that the doctors in Germany no longer had any advice about his pain and advised him to undergo psychiatric treatment. Only by the treatment in Turkey he had become almost pain free.
The costs incurred are relatively low and, finally, he does not claim any further expenses, such as Travel and flight costs.
The LSG did not follow. A reimbursement is basically only possible for treatments that are not affordable in Germany or for emergencies. However, a Lyme disease can be treated well in Germany.
The plaintiff was by no means exhausted in Germany, because he had previously visited only doctors in his immediate vicinity and did not consult any specialist doctors.
If treatment is planned, there is no medical emergency
"The plaintiff did not even set out in detail which concrete therapy, which was allegedly not to be possible in Germany, was allegedly successfully treated in Turkey," states the verdict.
Only the subjective success of an unspecified treatment can not claim reimbursement. Furthermore, there is no medical emergency in the case of planned treatment.
Nor has the court assessed the previous application to the health insurance fund, as the applicant claims, as an unnecessary formality, but as a necessary prerequisite for granting benefits.
A previous application would have made it possible in particular to seek advice on further specialist medical treatment in Germany. (Ad)