Assistive technology

In the field of rehabilitation aids " items that are required in each case to ensure the success of a medical treatment to prevent an impending disability or compensate for a disability, if they are not to be regarded as a general utility items of daily life " ( according to the Social Code SGB V § 33).

Taken from the Anglo- American world, the term Assistive or Assistive technology is used for this purpose.

Different tools overviews

This definition is of particular importance for the payers of resource supply, in particular the statutory health insurance (SHI ). The for the Statutory Health Insurance ( SHI ) the debtor aids are defined in the resource directory of the SHI listed (according to § 139 SGB V) and as individual products manufacturers on request.

Compared to the tools directory of the SHI offers the standard EN ISO 9999 " Assistive products for persons with disability - Classification and terminology " a broader and not oriented to the performance obligation overview of aids for disabled people. Through the international orientation and the translation from English, this classification also has a specific different terminology, some of which is not consistent with the terms used in German-speaking countries.

Obligation of the health insurance

The health insurance companies are required to provide their members with the indication ( reason reason ) appropriate aids. The indication is of the contract doctors of cash (defined in the Federal Mantelvertrag for Doctors [ BMV- Ä § 30 ] ) was observed. Patient care is done by the service providers ( retailers such as medical suppliers, pharmacies, orthopedic surgeons ). The funds are required as a rule to require their members to a deductible. This co-payment ( deductible) is of insured persons who have reached the age of 18, to be paid in the amount of 10 % of the selling price, but at least 5 euros and a maximum of 10 €. For the part of the public health insurance eligible regulation the prescription form to be used in the specific Regulation. Persons who are not insured by a statutory health insurance, in contrast, get the prescription on a " private prescription " form.

Addition is defined, is that the regulation of aids as opposed to remedies through the cashier to check and approve. The audit includes aspects

This is a misuse are excluded. The rejection of a resource by the SHI is only allowed in the rule when it reaches a better therapeutic benefit through a different supply. A rejection of the meaning from claiming that the target resource is too expensive and uneconomical, is not required by law.

Doctors are allowed next to the private settlement (also in BMV- Ä § 30) prescribe aids.

Types of aid

Among the tools in this sense include, for example, vision aids, hearing aids, prostheses, orthopedic custom made, wheelchairs, canes, walkers, etc. Almost all the resources for rehabilitation are at the same medical devices in accordance with the Medical Device Directive (MDD in the definition of § 3).

Tool or object of daily use

In the definition of the SGB V § 33 sentence 1 of the objectives of aids are described. It says: " Insured claim to be supplied with hearing aids, prostheses, orthopedic and other aids that are necessary in individual cases to ensure the success of medical treatment to prevent an impending disability or compensate for a disability, unless the tool not as a general commodities to see the daily life, ... "

A shoe is an object of utility for a healthy person. He can select the shoe according to his style and comfort desires and needs him to pay yourself. For sick or disabled people can be a shoe which is specially shaped, representing a difference / reduction of disability or a means of rehabilitation. It can also be a protection against a particular health hazard. So shoes are usually objects of everyday use, but can also be an aid in connection with an illness or disability.

Many items of daily use are determined by the indication in the status of a resource. Indeed, it will also result in many limiting cases of the assessment. Is a nursing bed as necessary preparations, and then heard the bed frame to the resource or is this again a subject of daily necessities to the POS member must pay yourself? In these questions the distinction between aid and commodity will always be difficult. In general, the health insurance covers the cost of the bed frame for hospital beds, as both are in solid ( bolted ) connection to each other.

Tool with extended functionality

Not so with the question of the functions of aids. In many cases, ranging from a traditional nursing home bed to care for the patient. But there are diseases in which housing beds with extended functionality ( Aufstehbetten, floor beds) significant benefits. The expanded range of functions affects the cost of procuring the funds. Regulation is often rejected in these cases by health insurance. As a reason for rejection is stated that the supply was sufficient with a simple remedy and therefore the tool with the extended functionality would not be economical.

This argument is not conclusive, because not without reason that the contract physician ( doctor with an approval of the health insurance ) prescribed for the corresponding resource. Here the insurance company may refuse only if it explains what the patient or the care environment provides the advanced features of no benefit. Using the example of the extended functional scope of a Aufstehbettes this is easily recognizable. With a stand-up bed ( patient may be an electric motor driven from lying to sitting), many patients with diseases such as Parkinson's, stroke, MS, etc. either stand completely on their own or require little support in this process. This leads to a noticeable increase in self-employment and to partially compensate for the disability. At the same time serving environment is physically relieved. Is expectable that these goals for the patient by the resource (in this example: a Rising ) are reached, the insurance company may not refuse the supply of this resource. In addition, remains at the box office often means the may no longer be necessary after the acquisition of the appropriate auxiliary aids and supports further consideration.

Aid list the statutory health insurance in Germany

According to SGB V § 139 " resource directory, quality assurance tools ," the central association of health insurance creates a systematically structured resource directory in which the covered by the obligation aids are listed. This indication- or mission-related quality requirements for aids can be established to ensure an adequate, expedient and economical supply.