What are common disputes between patients and insurers?

"It's often about sick pay, the calculation of health insurance contributions and the provision of remedies and aids."

Isn't it specified exactly what the health insurance fund has to pay?

"Yes, the statutory health insurance funds' obligation to pay is regulated in the German Social Code. The insurers check whether the insured person is entitled to benefits based on the specifications. However, depending on the interpretation, the health insurance company and the insured person may come to different conclusions."

What should I do first if a service is canceled?

"If the refusal is made by telephone, it is best to ask for written confirmation immediately. You need the written rejection notice so that you can appeal against it."

Are there formal conditions for an appeal?

"Yes, the appeal must be submitted in writing to the health insurance fund within one month of notification of the rejection decision. It is best to send it by registered mail or in advance by fax. Of course, you can also hand it in personally at your branch and ask for a receipt - this way you have proof that it was received on time in case of doubt."

Do I have to explain the content of my letter?

"No, you are not obliged to give reasons for your objection. As a rule, however, it makes sense to do so. If the dispute is about the medical necessity of a service, the Medical Service of the Health Insurance Fund (MDK) will draw up an expert opinion. In this case, you should request access to the files in order to find out the reasons for refusal and to be able to take a detailed stand against them. You can also ask your doctor to make a statement after the MDK report has been submitted."

Objection rejected - what can I do now?

"You can take legal action before the competent social court within one month of being notified of the rejection. The proceedings are generally free of charge for you and you can conduct the legal dispute yourself - without a lawyer. However, depending on the dispute, it may be advisable to consult a lawyer."

You can get support here

If you have any questions, you can contact the Unabhängige Patientenberatung Deutschland (UPD) - by telephone on 08 00/0 11 77 22 or at www.patientenberatung.de. Here you can obtain general information on insurance law issues and also find out exactly which requirements must be met for a particular benefit you have applied for to be approved. You can then refer to this in the reasons for an objection. If you need specific help in formulating your objection, it is best to contact a specialist lawyer for social law or a local social association.