How successful is an objection to the provision of medical aids with health insurance companies?

The regular process for the provision of medical aids consists of the medical decision and prescription of a medical aid, the consultation and testing by a medical aid provider (medical supply store) and the submission of a cost estimate (from the medical supply store) to the health insurance company. The health insurance company rejects some of the applications for medical aids. The decision is usually sent to the insured person (patient) and in parallel to the medical aid provider (medical supply store). The frequency and reasons for rejection vary greatly.

A scientific evaluation of the provision of medical aids in Germany showed striking differences between different statutory and private health insurance companies (with a higher rejection rate for private health insurance companies). There was a very high rejection rate for rare, complex and cost-intensive medical aids in particular (up to 30% of all prescribed medical aids). In the event of a rejection of the requested medical aid by the health insurance company, an objection is always advisable. In some cases, an informal letter of objection alone will be successful (“I hereby object to your refusal to provide me with the aid XXX”).

In the case of complex and cost-intensive assistive devices, it is advisable for an ALS center to decide on the provision of assistive devices and for a specialist medical supply retailer (with expertise in ALS care) to provide advice and trials. Specialized ALS centers and medical supply stores have experience in the medically and economically justifiable provision of assistive devices and the necessary documents for successful provision. Only in exceptional cases is legal assistance necessary (specialist lawyers for social law) in order to obtain the provision of necessary assistive devices.