Health insurance and care insurance are mandatory in Germany. Every citizen must be insured either through public or private insurance. The access to private health insurance (DKV) is limited.
Like all private insurances the principle of private health insurance functions on the basis of cost repayment. This means that the patient must first pay the doctor or hospital and can then be refunded through the health insurer. Unfortunately again and again there are cases where the private health insurer refuses to pay. This becomes especially clear in relation to aids/tools, which are regulated in great detail in the insurance terms. For this reason, patients should check the contract and insurance terms before taking out private health insurance to be clear about what their specific contract includes. Often it is argued whether a medical procedure/treatment is necessary or not. Here the private health insurers often refuse to pay benefits unfairly. The most common unfair refusals of benefits are in relation to:
- cost reimbursement for LASIK operations
- cost reimbursement for fertility treatment
- cost reimbursement for dental treatment, especially dental prosthesis with implants
- cost reimbursement for hospital treatment in certain clinics and convalescent homes
- payment of sickness allowances
The insured should not readily accept the relevant refusal of benefits from their private health insurer as they have an entitlement to this benefit. In addition, the danger exists that the insurer will in future always refuse to pay or reduce invoices submitted.