Incontinence aids on prescription: when the statutory health insurance pays

 Incontinence of urine and/or bowel movements affects many people. Find out here which incontinence aids are available and when the health insurance company pays for them.

The essentials in brief:

• Incontinence aids are aids and therefore benefits of statutory health insurance. 
• In order for the health insurance company to pay for your incontinence aids, you need a doctor's prescription.
• Your health insurance company will name one or more contractual partners who can ensure the supply of incontinence aids.
• Specialist dealers are obliged to provide personal or telephone advice.
• The legally prescribed personal contribution is 10 percent of the reimbursement amount or a maximum of 10 euros per month.

How incontinence aids work

In the case of incontinence of urine and/or bowel movements, there are aids that are financed by health insurance, so-called incontinence aids . These include absorbent incontinence aids that absorb and store urine or collect liquid stool.
Incontinence aids include:

1. Templates that can be worn in close-fitting underpants or in so-called net pants for fixation
2. Resealable diaper pants with Velcro or adhesive strips
3. Incontinence underpants, so-called "pants", which are put on like normal underwear

Absorbing incontinence products have a multi-layer structure: A soft inner fleece and absorbent and odor-binding materials prevent moisture on the skin and bind odors. In addition, absorbent incontinence products consist of a moisture-proof top layer and a breathable outer layer.

Incontinence aids enable participation in social life. It is all the more important that you find the right aids of good quality. When choosing the right incontinence product, it helps to consider the following.

are relevant 

1. Size and weight
   There are incontinence aids in different sizes. What is the physique (e.g. abdominal and hip circumference) of the person concerned?
2. Drinking amount
   How many liters does the affected person drink per day?
3. Absorbency
   There are incontinence aids with different absorbency levels. How severe is the incontinence?
4. Gender
   Many absorbent aids are equally suitable for women and men. But there are also gender-specific tools.
5. Skin problems Do you have any skin
   problems? This can be decisive for the choice of material.

How do I apply for incontinence aids

People with statutory health insurance are entitled to be supplied with absorbent incontinence products. These are listed as product group 15 in the list of medical aids.

Important: In order to receive incontinence aids at the expense of the health insurance companies, you first need a doctor's prescription .

• Health insurance pays for incontinence aids if there is at least moderate (guide value: more than 100ml in 4 hours) urinary and/or fecal incontinence.
• The prescription should contain the diagnosis, the name of the prescribed article and the required quantity or the supply period. It is also important that the regulation states why the aid is required. For example, it can be explained here that the incontinence aid is necessary for "participation in social life". The more precise the doctor's prescription, the easier it is to get the incontinence aid you need.
• If you constantly need incontinence material, it makes sense to get a permanent prescription from the doctor. The long-term prescription for incontinence material usually runs for several months.
• Good to know: In principle, there is a monthly number limit for incontinence aids . If you need more incontinence material on prescription, you can ask your doctor. You have the right to more material if you can prove that you need more. 

How is the supply carried out?

People with statutory health insurance are entitled to adequate, appropriate and economical care that does not exceed what is necessary. This means: You have a legal right to individually required incontinence products of sufficient quality and quantity.

If you want a special incontinence product or a larger number than necessary, you must bear the additional costs yourself . 

People with statutory health insurance can only obtain the incontinence products they need from service providers with whom their health insurance company has concluded a contract . Service providers are, for example, medical supply stores and pharmacies.

After receiving the doctor's prescription, you should contact your health insurance company . The health insurance company will give you the addresses of medical supply stores or pharmacies that have concluded a supply contract with the respective health insurance company for the delivery of incontinence products. If your health insurance company has only one contractual partner, you can only obtain the incontinence aids from this exclusive partner at the expense of the health insurance company.

Attention: Anyone who purchases an incontinence product from a medical supply store or another specialist retailer with whom there is no contract with their health insurance company must pay all costs that are above the price agreed with the contractual partner of the health insurance company themselves.

The medical supply store or pharmacy may only hand out products on prescription that are included in the list of medical aids of the statutory health insurance companies or that meet the standard specified in the register of medical aids. If there are several models to choose from, you can test the different variants.

As a person with statutory health insurance, you are entitled to 

1. Advisory, 
2. customization and 
3. briefing 

to the company that supplies them with incontinence products. The specialist dealer, eg the medical supply store, is obliged to find the right product with you. Therefore, the templates must be selected and adapted individually. The specialist dealers are obliged to offer personal or telephone advice to determine the individual supply requirements. In addition, they must inform those seeking advice about the health insurance benefits. If customers want this, they must also be advised at home.

You are also entitled to delivery in neutral boxes . The delivery quantity must correspond to your spatial possibilities. In principle, the contractual partners must comply with the agreed delivery times of 24 to 72 hours. In addition, an advice hotline must be maintained.

Good to know: If the products that are available to you as part of standard care do not meet your individual needs for medical reasons, you should speak to your health insurance company before you buy the desired product yourself. In such cases, a medical certificate from your doctor can also be helpful. In justified exceptional cases, health insurance companies can approve care that deviates from the standard requirement.

However, if you want a higher-quality incontinence product without medical necessity or would like to purchase a larger number of incontinence pads, you must bear the additional costs as your own contribution.

Who bears the costs for incontinence aids?

Statutory health insurance companies cover the costs of standard care with incontinence aids. Medical supply stores and pharmacies then settle the bill directly with the health insurance company. The supply of incontinence aids and thus also the costs are regulated in negotiation agreements, the so-called accession agreements.

The statutory health insurers then pay the amount agreed with pharmacies or medical supply stores. The basis for billing is a monthly flat fee . You can ask your health insurance company about this monthly flat-rate payment. It often ranges between 16 euros and 32 euros .

At their own request, the insured person can receive a higher-quality supply of incontinence products. The difference between the reimbursement from the health insurance fund and the actual price, the so-called additional costs, is paid by those affected out of their own pockets . This surcharge should not be confused with the statutory co-payment (see next point).

How much is the co-payment?

The co-payment for aids is regulated by law. There is a special regulation for "consumable aids". These are aids that can only be used once - incontinence aids are one of them. The additional payment depends on the monthly requirement. According to this legal regulation, patients have to contribute 10 percent or a maximum of 10 euros to the cost of the reimbursement amount for the monthly requirement.

An exception are children and young people up to the age of 18. You do not have to make any co-payment.

help with problems

In the event of conflicts with the delivery company, customers should immediately contact their responsible health insurance company . This must ensure that the necessary service is provided and that its insured receive the necessary assistance at short notice and in the right quantity and quality.

If the situation cannot be regulated in their favor, insured persons can also switch providers. Most cash registers have contracts with several retailers. They must inform their insured persons of this.

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