Aids (rehabilitation)

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In the area of rehabilitation, according to the Aids Directive of the Federal Joint Committee, aids are "items that are required in individual cases to ensure the success of a patient's treatment, to prevent an impending disability or to compensate for a disability, insofar as they are not regarded as general objects of daily use are".

The terms assistive or assisting technology or support technology are also used for this purpose from the Anglo-American language area or translated (from assistive technology ) .

Various resource overviews

This definition is of particular importance for those who pay for medical aids, in particular statutory health insurance (GKV). The aids that are subject to statutory health insurance (GKV) are defined in the aids directory of the GKV and listed as individual products upon manufacturer application.

Compared to the GKV list of aids, the EN ISO 9999 standard “Aids for people with disabilities - classification and terminology” provides a more comprehensive overview of aids for disabled people that is not based on the obligation to perform. Due to the international orientation and the translation from English, this classification also has a specifically different terminology, which in part does not match the terms used in German-speaking countries.

Obligation of health insurance companies

The health insurance companies are obliged to provide their members with appropriate aids according to the indication (reason, occasion). The legal basis here is § 33 SGB ​​V. The indication is determined by the contract doctors of the health insurances (stipulated in the federal contract for doctors BMV-Ä §30) and prescribed accordingly (health insurance prescription). The care of the patients is done by the service providers (specialized trade such as medical supply stores, pharmacies, orthopedists). As a rule, the health insurers are obliged to demand a statutory additional payment from their members. This additional payment is to be made by insured persons who have reached the age of 18 in the amount of 10% of the sales price , but at least 5 euros and a maximum of 10 euros. For the prescription that is reimbursable by the statutory health insurance, the prescription form must be used in the prescribed form. In contrast, people who are not insured through statutory health insurance receive a prescription on a “private prescription” form.

In addition, it is stipulated that the prescription of aids, unlike medicinal products, must be checked and approved by the health insurers. The exam covers the aspects

  1. the therapeutic and qualitative benefit. It should be examined whether a similar or a different aid can achieve the same or better therapeutic benefit. The medical diagnosis or the prescribed therapeutic path of the contract doctor is not up for discussion here.
  2. the economy of the aid. It should be checked whether a corresponding aid is available and can be used in the inventory of the cash registers.

This is to rule out incorrect supply. The rejection of an aid by the GKV is usually only permitted if it achieves a better therapeutic benefit through another care. The legislator does not provide for a rejection on the basis that the desired aid is too expensive or uneconomical.

Doctors may also prescribe aids for private billing (also in BMV-Ä §30).

Aid or object of daily use

Tools with extended functionality

In many cases, a conventional care bed is sufficient to care for the patient. But there are diseases in which beds with extended functionality ( Aufstehbetten bring substantial benefits, floor beds). The extended range of functions affects the procurement costs for the cash registers. In these cases, the ordinance is often rejected by the health insurers. The reason for rejection is that the supply with a simple aid is sufficient and therefore the aid with the extended range of functions is not economical.

This argumentation is inconclusive, because it is not without reason that the contract doctor (doctor with a health insurance approval) has prescribed the appropriate aid. Here, the health insurance company may only refuse if it explains which of the extended functions are of no benefit to the patient or the caring environment. This can easily be seen in the example of the extended range of functions of a stand-up bed. With a stand-up bed (the patient can be driven from lying to sitting by an electric motor), many patients with diseases such as Parkinson's, stroke, MS, etc. can either stand up completely independently or require little support in this process. This leads to a noticeable increase in independence and partial compensation for the disability. At the same time, the physical environment is relieved. If it can be expected that these goals will be achieved for the patient by the aid (in the example: a stand-up bed), the health insurance company may not refuse to provide this aid. In addition, the cash registers often do not take into account the savings in additional aids and support that may no longer be necessary after purchasing the corresponding aid.

See also

further reading

  • Kamps, Norbert: Basics of the supply of auxiliary and care aids: Working aid for SGB V and SGB XI; Introduction to the list of resources ; Walhalla and Praetoria; 1st edition; October 8, 2009
  • Mischker, Andrea: The initial supply of aids for patients after a femoral fracture close to the hip - a comparative study on three groups of mobility aids in ... safety, effectiveness and quality of life ; Man & book; 1st edition; March 2009
  • Kamps, Norbert: Practical series “Fachkompetenz Pflege” - Volume 3: Aid supply for those in need of care, legally secure aids management in nursing practice ; People and media; 1st edition; September 2010
  • Gerlach, Werner: TTH - therapies and technical aids - current lexicon for doctors and health insurance companies with product information and images ; Walhalla and Praetoria; Loose-leaf collection; December 2010 (continuously updated)

Web links