Applying for aid - how does it work?

 Find out here which process you should follow so that the statutory health insurance company can process your application for an aid as smoothly as possible.

The essentials in brief:

• The aid is usually prescribed by doctors. It may make sense for them to justify here why the aid is required.
• With this ordinance, you can apply for the aid from the statutory health insurance company. 
• The application for approval is submitted to the health insurance company, sometimes other payers are also possible.

What should you consider when visiting a doctor? 

In order for your health insurance company to approve an aid, you need a prescription from your doctor. This prescription is always required for initial treatment with an aid. The doctors decide which aid is useful and necessary in your situation. For the evaluation and classification, there is a so-called aid guideline and an aid index . Make sure that the prescription is filled out as precisely as possible. It is essential that the prescription states that it is medically necessary. 

If only a specific aid is suitable for you, the doctors should clearly name the aid. It is best to name the specific aid number from the index of aids directly. It is also advisable to provide a reason why only this special aid is suitable. For example, because you have already tried others and/or there are special restrictions. In addition, the prescription should contain the diagnosis, the number, the date, the method of manufacture if necessary and, if necessary, the number of quantities for days or months.

Tip!

If the doctors refuse a prescription for an aid because of a limited contingent of prescriptions, point out to them that aids are not included in the medical budget and therefore do not burden the budget. Aids are not included in the medical budget. Your doctors therefore do not have a limited contingent of prescriptions, but can only orientate themselves on medical necessity.

With the regulation for application 

If you have received a prescription, contact your health insurance company and apply in writing for the provision of the aid. The health insurance company will explain the next steps to you, decide on the application and tell you how and through which aid provider you can be supplied. Some health insurance companies offer their own apps for support. 

What are nursing aids?

There are aids that are necessary because of an illness or disability as well as care aids. If a degree of care has been determined for the insured person, the health insurance company or care insurance company from which the aid is applied for will check its own responsibility. The insured do not have to choose the right carrier themselves, but can apply to the health insurance company or the nursing care insurance company. The prospective institution finally decides on both claims and the approval. 

Tip!

If the applicant is in need of care and an application for the provision of medical aids is denied, check whether a decision has been made on both claims. 

Which cost bearers are still possible? 

When it comes to covering the costs for an aid, there are several cost bearers to consider. Especially if this serves to prevent a disability or to compensate for a disability. In most cases, the statutory health insurance is the right address.

Depending on the purpose or reason for which you need the aid, the health insurance company can also

• pension insurance (participation in working life),
• Accident insurance (after an accident at work or on the way to work or in the case of a confirmed occupational disease),
• the employment agency (participation in working life) or
• the social welfare office (in individual cases)

bear the costs. If you have applied for the aid from the wrong payer, they must forward the application to the correct one. If this is not done in time, the application must be processed further by the previous payer. 

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