FAQS

Do you need an aid and are you entitled to a social insurance provider? This could be, for example, the health insurance company or the professional association, which usually covers the costs. Coverage of costs requires that a doctor's prescription (prescription) is available to the cost carrier. The prescription must specify the aid in question with a reason (diagnosis).

Each of us is entitled to high-quality care that is progressive and corresponds to the generally accepted state of medical knowledge. First, the responsible funding body checks whether the prescribed aid complies with the current legal requirements for compensating for a disability or for therapy and is medically necessary.

If the cost carrier considers the treatment to be medically necessary, the insured person will receive a letter of approval by post. The medical supply store will then also receive the notice to carry out the treatment.

As an insured person of the cost carrier, you can lodge an objection with the cost carrier. This can be done in person, in writing or verbally by making a written objection to the cost carrier. You have four weeks from the time you receive the notice to lodge an objection with the cost carrier. The process is free of charge.

If the rejection notice is revoked after a further review of the situation, you will receive a remedy notice and the care can now be carried out by the commissioned medical supply store.

IS A FREE CHOICE OF THE HEALTH CENTER AS LEGAL

As with the provision of pharmaceuticals, the legislature has determined that those with statutory insurance must make co-payments of 10%, unless there is a so-called exemption for the current calendar year.

All those with statutory insurance are entitled to be provided with aids as part of medical treatment, should these be necessary to alleviate or cure an illness or its symptoms, or to prevent it from getting worse. An aid must be required to ensure the success of hospital treatment, to prevent or compensate for a possible disability. In terms of “compensating for a disability,” it is sufficient here if the aid replaces, facilitates, or supplements the restricted function of a body part. If a medically necessary aid serves the individual needs of a patient and their disability compensation and is not used solely to make care easier, it can generally be prescribed. The provision of the service lies with the health insurance company. In institutions, the service is limited to personal disability compensation, so a toilet chair, for example, can be provided by the inpatient facility, but can be approved and provided in outpatient care.

If medically necessary aids are required, the application must be submitted primarily to the health insurance company.