Aids from the health fund: enforce approval

The health fund has to provide medically necessary aids that secure the success of the treatment, prevent a disability or compensate for it. If an aid is refused or offered only with a high surcharge, an objection is worthwhile, because a sufficient, appropriate supply has to be possible without a surcharge.

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Your chances of getting your money back

You have a claim to medically necessary aids that compensate for a disability or secure the treatment success (§ 33 SGB V). A sufficient and appropriate supply has to be possible without a surcharge.

Surcharges are only permitted for comfort or special requests that go beyond what is medically necessary, not for the necessary basic supply. If refused, you can object within one month.

What you should do now

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1. Secure the prescription
Have the aid medically prescribed and the medical necessity justified.
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2. Check the surcharge
If a high surcharge is demanded, ask for a surcharge-free, sufficient supply. This has to be offered.
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3. Lodge an objection
If refused, object on time and refer to the entitlement under § 33 SGB V.
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4. Urgent application if urgent
If you urgently need the aid, an urgent application to the social court is an option.

How to spot the scam

For a necessary aid, a high surcharge is demanded across the board.
No surcharge-free alternative is offered.
The refusal gives no concrete medical justification.

Frequently asked questions

Which aids does the health fund pay for?

Medically necessary aids that secure the treatment success, prevent a disability or compensate for it, such as wheelchairs, hearing aids, prostheses or care beds (§ 33 SGB V). A sufficient, appropriate supply has to be possible without a surcharge.

Are surcharges permitted?

Only for comfort or special requests that go beyond what is medically necessary. For the necessary basic supply, no surcharge may be demanded. Insist on a surcharge-free, sufficient supply.

What if the aid is refused?

Object within one month and submit the medical justification of the necessity. For urgently needed aids, an urgent application to the social court can make sense.

Take action now

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General information for self-help, not legal advice (RDG). In case of a high loss or uncertainty: contact a consumer advice center or a lawyer.