Doctors are responsible for ingrown toenail

Medical care gaps do not justify going to the podiatrist

Insured persons can have an ingrown toenail treated at cash costs only at the doctor, even if they do not find a doctor for this. Since it concerns a medical supply, the legal health insurance companies may not reimburse the treatment costs with a qualified medical podiatrist, judged on Tuesday, 18. December 2018, the Federal Social Court (BSG) in Kassel (Az .: B 1 KR 34/17 R ).

This leaves a Berliner on the cost of a podiatrist sitting. She had tried in vain to find a doctor who was ready to treat her chronically ingrown toenail. She then went to a medical podiatrist. This treated the woman with a customized wire toe nail clip.

The Berliner wanted to be reimbursed by her health insurance. The podiatrist was also sufficiently qualified.

Although the health insurance of the applicant took over the material costs, but not the treatment costs for the podiatrist amounting to 152 euros. This is a medical care service that only doctors are allowed to provide for health insurance. The health fund acknowledged that doctors do not provide this therapy "nationwide", especially since this is not taught in the medical training. The legal provisions are however clear.

The Landessozialgericht Berlin-Brandenburg awarded the plaintiff the reimbursement. There is a "system failure" here. She was entitled to treatment, but no doctor was willing to carry it out. In such a case, the health insurance would also reimburse the cost of treatment to the podiatrist.

But the BSG reversed this decision. It concerns here "a service reserved for the physician". The fact that the applicant did not find any doctors to treat her medical foot problem does not give rise to any claim for reimbursement of the service provided by the Podiatrist herself. If necessary, the woman could have done the treatment with a private doctor and then the costs can be reimbursed by the cashier.

There is one exception only in diabetic foot syndrome. Here it is exceptionally podiatrists allowed to treat this on cash costs independently. fle / mwo