Health insurance companies often refuse benefits

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Insufficient health care due to denied health insurance benefits?

In Germany, patients are increasingly being denied help. Statutory health insurance companies tend to reject benefits such as sick pay, rehabilitation measures or hearing aids. This comes from figures from the medical service of the National Association of Statutory Health Insurance Funds. The Federal Minister of Health has now also intervened.

Hundreds of thousands of negative notices
The statutory health insurance companies in Germany are increasingly refusing to help their approximately 70 million members. Hundreds of thousands of health insureds received negative feedback from their insurance company in 2012 on benefits such as rehabilitation measures, aids or sick pay, reports the news agency "dpa", citing current figures from the Medical Service of Health Insurance (MDK). In 16 percent of all health insurance reviews initiated by health insurers, experts came to the conclusion that the employees were healthy and could work again. Of the nearly 700,000 applications for rehabilitation services reviewed, 39 percent were rejected and almost 500,000 expert opinions were produced for aids such as hearing aids, with negative judgments in 37 percent of the cases.

Politics intervenes
The Rhineland-Palatinate CDU member of the Bundestag Erwin Rüddel, who represents his parliamentary group in the health committee of the Berlin parliament as rapporteur for patient rights, points out that the health insurance funds are obliged by the new patient rights law to decide on applications for insured persons within three weeks. "If the health insurance companies interpret this rule in such a way that they reject applications 'as a precaution', this would reverse the meaning of the law. That is why we will now take a very close look at the practice of health insurance companies when dealing with the applications of their insured, ”says Rüddel. Federal Minister of Health Daniel Bahr (FDP) has now also taken action. According to, he wrote a strict letter to the umbrella organization of statutory health insurers (GKV) and to the top insurance supervisory authority of the Federal Insurance Office, demanding "examination and comments" on the allegations of "rejection of benefits by statutory health insurance funds". The deadline for an answer ends on August 28.

File an objection
Experts point out that it may be possible and sensible to object to rejected measures. Rüddel also recommends that those affected do not simply accept a possible rejection notice: “Of course, you can object to this and the doctor treating you can request a second report. In addition, in such cases, the independent patient counseling service in Germany is available to help and advice. ”

Mentally ill and frail old people
However, this is hardly possible for certain patient groups. For example, frail old people and the mentally ill are often helplessly exposed to the health insurance bureaucracy. For some of these patients, the suffering of the disease is compounded by the fact that they are confronted with the insensitive behavior of the health insurance staff. So there would be calls to motivate the sick to work again. Employees also often conceal mental illnesses out of fear of losing their job or out of shame. Because mental illnesses are still considered taboo.

Health insurance companies as winners The winners of these practices are probably the health insurance companies themselves. In this way, each rejected service improves the balance sheet of the insurance company. Since 2009, the health insurance companies have also been granted risk structure compensation for particularly cost-intensive patients, but this does not apply to the mentally ill. This group of patients should work as quickly as possible or even leave the cash register. The lack of understanding becomes all the greater if you also take a look at the till. In the first quarter of 2013, the statutory health insurance companies generated a revenue surplus of 850 million euros. This is obviously also due to, among other things, rejected services. Some health insurance companies pay bonuses to their members, but only to those who would not incur any costs anyway.

Doctors increase revenue While patients receive less and less help, in addition to health insurers, doctors also increase their income. This is partly criticized by the health insurance companies. So the board of the AOK federal association, Uwe Deh told the magazine "Focus": "It remains open what value the insured received for an income increase of 17 percent." It was unacceptable that individual groups of doctors could increase their income by up to 35 percent could increase and others not at all. Another problem that is exacerbated by rejected health insurance benefits is the principle of self-medication. In pharmacies, for example, every prescription drug sold now comes with an over-the-counter one. Ten years ago there were only half as many. Health insurance patients would not only have to do without a wide range of services, but would also pay their medication more often out of their own pocket. (ad)

Photo credit: Rainer Sturm /

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