School medicine clause
The conventional medicine clause is a clause in the model contract terms of the German Association of Private Health Insurance Companies . It states that drugs and medical treatments are only paid for if they are either "predominantly recognized by conventional medicine", "have proven to be just as promising in practice", or are without conventional medical alternatives. In the event of a dispute, the patient or his practitioner is required to provide evidence of the "probation in practice" or the lack of an alternative.
The clause replaces an older "scientific clause" and has been accepted in the highest court rulings.
Similar principles apply to the assumption of the costs of innovative or alternative medical procedures by the statutory health insurance after individual decisions, which has led to the case law of the social and civil courts converging on this point.
Sources and individual references
- ^ Association of Private Health Insurance eV: Section 4, Paragraph 6, model conditions 2009 for medical expenses and daily hospital allowance insurance . (PDF, as of January 2017)
- ↑ Peter M Hermanns, Gert Filler, Bärbel Roscher: Billing Alternative Medicine 2014: Methods, Indications, Billing Examples . Springer-Verlag, 2013, ISBN 978-3-642-45033-4 , pp. 20 ( google.com ).
- ↑ G. Nitz: The "school medicine clause" is effective. IWW- "Abrechnung Aktuell" 02/2003, S. 1 (accessed May 28, 2018)
- ↑ A. Mummenhoff: Does private health insurance have to pay for alternative treatments? (Blog post undated, accessed May 28, 2018)
