Ombudsman at the health insurance company
Since the health reform, health insurance has been compulsory for all citizens living in Germany. You can insure yourself with statutory health insurances or private health insurances. Patient representatives and medical associations are contacts for those with statutory health insurance. An ombudsman represents the interests of private patients.
Members of the statutory health insurance can, among other things, contact the Federal Insurance Office contact for GKV. The first way you should always go straight to the respective one Health insurance and lead to regional supervisory authorities.
Health insurance companies must provide insured persons with comprehensive information
Statutory health insurance companies must inform their insured persons complaints and accept objections and process them accordingly. They can also get advice from associations of statutory health insurance physicians.
- The Independent Patient Advice Service (UPD), with contact points throughout Germany, is open to every citizen regardless of a certain type of insurance. Consultations are offered by doctors and lawyers.
- As a member of a private health insurance company, you are responsible for your concerns ombudsman "Private health and long-term care insurance" or a patient advocate at the hospital.
Patient advocate for all patients
The hospital ombudsman is required by law in some federal states. Such independent patient advocates exist in, for example, Rhineland-Palatinate, Berlin and Hesse.
Who has statutory health insurance or has to take out statutory health insurance, has ...
- They take care of the concerns of all hospital patients, regardless of whether they are members of a statutory health insurance company or a private insurance company. In the event of a hospital stay, ask whom and when (office hours) you can contact in order to receive advice.
- The Patient Rights Act, which has been in force since the end of February 2013, obliges hospitals nationwide to set up patient-oriented complaint management. Patients don't just have to be given the opportunity to complain. You must also be made aware of this.
Insurance Ombudsman
Members of private health insurers have been able to turn to the ombudsman for the insurance industry since 2001.
- This has the task of accompanying disputes between the insured person and the insurer or resolving them out of court. The neutral and independent arbitrator is paid by the insurance industry.
- Frequent questions about private health insurance include disagreements, among other things medical necessity, fees, pre-contractual notification requirements, additional dental insurance or professional Teeth cleaning.
An ombudsman can make binding decisions up to a value in dispute of 5,000 euros. In the case of higher amounts in dispute, he may only make recommendations.
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