The prepayment with the family doctor is a bogus package



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Mock pack prepayment from the family doctor: consumer advice centers, health insurance companies and social organizations issue a warning about the cost traps for statutory health insurers.

The plans of the federal government to expand reimbursement of costs in the healthcare system are a deeper hold in the pocket of the insured. This is criticized by the Federation of German Consumer Organizations (vzbv), the VdK Germany Social Association (VdK) and the Board of Directors of the AOK Federal Association. The organizations are calling on the federal government to abandon the planned legislative change and to protect the consumer from this cost trap.

In order to increase transparency in the healthcare system, the three associations are in favor of further developing the patient receipt tool. The patient receipt has been on a voluntary basis since 2004. It shows the performance and costs of a treatment. Ulrike Mascher, President of the Social Association VdK Germany: "The reimbursement of costs can lead to unpleasant surprises for insured persons if they remain at the expense of most of the costs after the treatment. Insured persons must therefore also be warned not to press doctors for treatment on account The social association VdK basically advises insured persons not to switch to reimbursement of costs. "

The federal government's plans to reimburse the costs mean that more legally insured patients should first pay for their doctor's visits and hospital stays themselves, and then have their health insurance reimbursed the amount of the bill. What sounds so harmless at first glance has a far-reaching impact for consumers on closer inspection:

If the consumer decides to be reimbursed, the doctor will invoice each individual service performed according to the private medical fee schedule (GOÄ) at 2.3 times the rate. That means the doctor gets more than double the previous income. However, the cash register may only reimburse the patient for the reimbursement of the costs specified by law. This results in large difference amounts of more than 50 percent, on which the consumer ultimately remains. AOK federal association Jürgen Graalmann, deputy chairman: "Reimbursement of costs does not solve a single problem in the health care system. It simply means one thing - the patients have to pay, the doctors collect."

Compared to the GKV, the private health insurance companies run away from the costs dramatically, they have to charge their insured persons ever higher premiums from year to year. One reason: Doctors treat private patients not only from a health point of view, but also from a profit perspective, at the expense of the insured. This development threatens to reimburse the statutory insured. An example shows the serious financial consequences that the insured would face:

A 68-year-old woman goes to the ophthalmologist with vision problems. Glaucoma (glaucoma) is diagnosed there. Since she opted for reimbursement, she receives a fee invoice. This amounts to 409 euros, because the doctor has billed according to GOÄ (2.3-fold rate). Your health insurance company pays 72 euros, so you have to pay the difference of 337 euros yourself.

The federal government plans to shorten the commitment period for reimbursement of costs from one year to three months. Doctors have an economic interest in patients opting for the prepayment model. There is a massive risk that patients will initially be reimbursed for a quarter in order to be preferred when appointing appointments in the doctor's office. Anyone who decides against this billing process is left behind and has to be prepared for longer waiting times by some doctors. There can hardly be any question of the voluntary nature put forward by the Federal Minister of Health Rösler. Prepayment from the doctor then means right of way for the full budget. The chairman of the consumer center Gerd Billen said: "Patients and doctors should know what a treatment costs. The appropriate instrument for this is the patient receipt, not the reimbursement of costs. After all, the current principle of benefits in kind ensures quality and efficiency in the health system."

Surveys have shown that, in contrast to those insured under statutory health insurance, privately insured people have the impression that they do unnecessary examinations and treatments. This risk will increase significantly for consumers who choose reimbursement for the reimbursement of medical services. (pm, Oct 22, 2010)

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