Patient transport on prescription: when statutory health insurance companies pay

 Some new rules have been in force for patient transport since October 2020. Here they are at a glance.

The essentials in brief:

• Cash patients can have trips to doctor’s offices or hospitals paid for by the cash register.
• You need a prescription for this, which doctors can only prescribe if the trip is medically necessary.
• There is no doctor’s prescription for travel to outpatient or inpatient rehabilitation measures. Ask your health insurance company directly about this.
• Patients with certain levels of care and severe disabilities can also take a taxi without prior permission from their health insurance company and have the travel expenses reimbursed.

Transport must be prescribed by a doctor

Anyone who is ill or has restricted mobility often needs a means of transport to get to the treatment practice, to the hospital or to rehabilitation measures. With the statutory health insurance companies, the assumption of the costs for patient transport is strictly regulated. Doctors may only prescribe ambulance transport if the journey is medically necessary.

In connection with a service provided by the health insurance company, only the journeys on the direct route between the respective place of residence of the patient and the nearest suitable treatment option are usually necessary. The location can be your own home, a nursing home or the scene of an accident. In addition, it must be a medical measure that is paid for by the health insurance company.

outpatient treatment

The health insurance companies only cover the costs for the doctor or dentist in a few cases. For example, if an inpatient stay can be shortened or avoided as a result of an outpatient operation. Costs for patients who have to undergo long-term treatment - such as radiation therapy, chemotherapy or dialysis treatment - are also covered. The statutory health insurers do not pay for other therapeutic treatments, such as massage or physiotherapy.

A doctor’s prescription is always a prerequisite for the assumption of travel expenses. This should be issued regularly before carriage. Only in exceptional cases, especially in emergencies, can carriage be ordered retrospectively. One speaks of an emergency when the patient's life is in danger or serious damage to health is to be feared if the necessary medical care is not provided immediately.

Attention: In most cases, the health insurance company has to approve these trips before they start. But there are exceptions.

Extension of cost coverage without the approval of the health insurance company

Under certain conditions, people in need of care and other people with restricted mobility can take a taxi to see the doctor without prior approval from the health insurance company. Anyone who has nursing care grades 4 and 5 or a severe disability with the mark "aG", "BI" or "H" can take a taxi for medically necessary trips to the doctor or dentist without prior permission from their statutory health insurance company then bears the costs. This also includes trips to psychotherapists. This regulation also applies to those affected with care level 3 if they are also mobility-restricted.

However, trips to pick up prescriptions or to request medical reports will not be reimbursed. This also applies to trips to change hospitals at your own request.

The simplification also applies to insured persons who do not have a severely disabled person's pass, but who are comparably restricted in their mobility and are being treated on an outpatient basis for at least six months.

The joint federal committee has now issued a guideline on the procedure for doctors and health insurance companies. According to the directive of October 1, 2020 , the imperative need for a regulation of the journey and the means of transport must be justified.

A prescription from the doctor treating you first is sufficient for the health insurance company to cover the costs. However, only ambulance trips by public transport, private vehicle, taxi or rental car are covered. If you are unsure in which cases this applies, you should clarify the assumption of costs with your health insurance company in advance.

Regulation for the transportation of sick people

There are special prescription forms for patient transport from the National Association of Statutory Health Insurance Physicians. This prescription is to be filled out by the doctor. The prescribing doctor must specify the following things on the prescriptions: 

• reason for the promotion
• Permit-free journeys

The journeys must always be acknowledged by the insured person. The ordinance contains a separate sheet for this.

type of transportation

Whether outpatient or inpatient treatment - the choice of means of transport always depends on the individual needs and state of health of the patient. However, the most economical alternative should also be chosen. Doctors should therefore first check whether patients can manage a journey by bus and train or their own car. If this is not an option, you as a patient can use a taxi or rental car. Rental cars also include, for example, cars with disabled facilities for transporting wheelchair users.

However, statutory health insurers only pay for the shortest route and check this if necessary.

By the way: Transports with the ambulance are not covered by this special regulation. These remain subject to approval if they are to drive to outpatient treatment.

Inpatient treatment

The prerequisite for the assumption of the travel costs to a clinic is always that the trip to a treatment is necessary for medical reasons and that the treatment is paid for by the health insurance company. In such a case, the doctors treating you are allowed to issue a prescription for the patient transport, which can then be settled with the statutory health insurance fund.

Patients do not have to submit this prescription to the health insurance company for approval in advance. This also applies to pre- and post-hospital treatment.

co-payment and billing

Insured persons have to shoulder part of the transport costs themselves. Regardless of the type of vehicle, the co-payment is ten percent of the travel costs, but at least five euros and a maximum of ten euros per trip, including for children and young people. The driver receives this amount immediately after the transport. Only insured persons whose co-payments have exceeded the load limit according to § 62 SGB V are exempt from further co-payments for the rest of the calendar year upon presentation of a corresponding certificate from the health insurance company. Anyone who has reached this load limit can request an exemption card from the health insurance company .

In some cases, the transport company settles accounts directly with the responsible health insurance company. In other cases, the patient applies in writing to the health insurance company for the travel costs to be covered, with the receipts (taxi receipts, train tickets or mileage records). The health insurance company will inform you on request how the billing works.

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