State aid advisor

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The aid advisor carries out a legal advisory and extrajudicial activity that is subject to authorization under the Legal Services Act . This applies to all areas of aid and insurance law and care. He represents German officials vis-à-vis state aid agencies and health insurances , long-term care insurance and other cost carriers in the event of problems such as claims settlement or insufficient benefits. He also advises in advance on cost-intensive measures in order to minimize the risk of reimbursement from the outset.

Field of activity

Aid advisors have the task of providing assistance in matters of aid, representing you in relation to health insurance companies and doctors, as well as providing advice on asserting claims against other cost bearers. The activity can be carried out independently or as an employee.

The tasks of the aid advisor mainly consist of forward-looking advice for optimal reimbursement, the preparation of aid and health insurance applications, cost assumption declarations for hospital stays, the subsequent review of aid notifications and reimbursement notifications from the health insurance companies as well as the representation of the client in disputes with the aid offices and by a authorized legal representative before the administrative court.

In detail, the following tasks are intended for a grant advisor:

  • Review of doctor-dentist bills according to GOÄ / GOZ
  • Review of treatment and cost plans (dentures)
  • Review of alternative practitioner bills according to the GbüH
  • Review of reimbursable medication and medical treatment e.g. B. Physiotherapy
  • Assignment of the checked documents to the respective cost bearers (aid agency, health insurance company, accident insurance company, etc.)
  • Allocation of aids and remedies according to the aids catalog
  • Preparation of grant applications for the client
  • Preparation of reimbursement applications for health insurance companies and other cost carriers
  • Preparation of applications for planned psychotherapy, healing cures and stays in a sanatorium for the client
  • Preparation of applications for advances on costs for inpatient hospital stays
  • Preparation of applications for long-term care insurance benefits
  • Review of the aid notice
  • Review of the cash register notification
  • Review of the maintenance notice
  • Support in negotiations with payers
  • Management of all correspondence with doctors and payers for the client
  • Representation before authorities, health insurances and doctors
  • Consulting services regarding:
  1. Own contributions
  2. Reductions in the cost bearers
  3. Flat rate cost containment (KDP)
  4. Own drug participation
  5. Other advice and representation (in particular with regard to health insurance that complies with subsidies)

Legal advice in other areas of law is not permitted (the attorneys' duty of reservation).

The aid advisor is liable to the client for the correctness of the aid advice and must take out professional liability insurance for this. The benefit advisor does not have to carry out the activities completely himself, but can avail himself of the help of expert staff (e.g. social security clerks). The condition is that the employees work exclusively in accordance with instructions under the technical supervision and professional responsibility of the aid advisor.

Billing

The work of the aid advisor is based on a service contract with the client regulated in the German Civil Code , which, according to §145 BGB, is not bound to a certain form and can even come about through conclusive action without express agreement . The aid advisor concludes a service contract with the client in accordance with §§ 611–630 BGB, which obliges him to perform the promised services (efforts to reimburse costs by mutual consent) and the client to pay remuneration.

According to § 611 BGB, the amount of the remuneration is left to the free agreement between the aid advisor and the client. The amount of the fee is usually based on the age of the client, the number of persons eligible for assistance and the state of health. Otherwise, the amount of the usual remuneration results from the provisions of the service at reasonable discretion (see Section 315 BGB). It is important here that the granting of remuneration (as with all other service contracts) does not depend on success. However, there is an obligation for the aid advisor to give conscientious advice, taking into account his duty to provide information and due diligence.