How much will the health insurance company contribute? | Connect Hearing

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Overview:

Requirements for cost coverage by health insurance companies
Hearing loss thresholds
Step-by-step guide to cost coverage by health insurance companies
Minimum hearing aid standard
Statutory health insurance companies cover a fixed amount
Care agreements with health insurance companies
Private health insurance companies must define an upper limit
No entitlement to the best aid

Requirements for cost coverage by health insurance companies

Health insurance companies are legally obliged to pay for hearing aids if they are considered medically necessary. However, in order to assess a subsidy claim, a number of requirements must be fulfilled:

Carrying out a speech audiometry by an ENT doctor: Level of comprehension must be below 80 percent in the speech audiometry.
Hearing loss must be within the range of major frequencies, between 500 and 4,000 Hertz, and, in the case of monaural hearing loss, must represent hearing loss of at least 30 dB.
The treating ENT doctor must issue a medical prescription, stating the need for a hearing aid. The physician must not refer to any specific hearing aid on the prescription.

The ENT doctor must only confirm the medical need for a hearing aid. The

audiologist

will provide assistance in the selection and fitting of the most suitable device.

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Step-by-step guide to cost coverage by health insurance companies

Hearing aid subsidies are often subject to bureaucratic obstacles that may not only delay cost coverage, but also result in frayed nerves.

To avoid such obstacles, bear in mind the following points:

Visit your ENT doctor and ask to have the extent of your hearing loss assessed while requesting a prescription for a hearing aid.
Take the prescription to your audiologist and ask for their expert advice. The audiologist is legally obliged to offer you a hearing aid for a fixed sum or contracted price. Only a prescription fee of EUR 10 per ear is payable. If it is medically necessary for you to wear a hearing aid that costs more than the fixed sum, this should be confirmed and explained in writing by your ENT doctor. Ask your audiologist to provide you with a cost estimate.
Submit a written application to your health insurance company. You may submit the cost estimate, along with a written application for the coverage of the costs and your physician's statement, to your health insurance company.
Be prepared to object to their decision. If your health insurance company refuses to cover all or some of the costs, you must submit your objection in writing within one month. Send the statement from your physician and the results of the fitting test, and, if necessary, a record of relevant dates, along with your objection. Request a statement from the health insurance company’s medical service (MDK). This is free of charge, and according to the principle of official examination, the insurance company is obliged to have your application medically assessed.

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Care agreements with health insurance companies

According to section 4 of the German Social Security Statute Book V, statutory health insurance companies can conclude agreements with care providers in order to offer their clients medical diagnoses, treatment, or aids, for example. In addition to physicians, pharmacists, physiotherapists, and hospitals, audiologists, as suppliers of hearing aids, are also regarded as service providers with whom health insurance companies have concluded health care agreements.

On the basis of health care agreements (in the case of audiologists pursuant to § 127 of the German Social Security Statute Book V), health insurance companies regulate the details of the care given by the service provider. This includes:

The nature and scope of chargeable services
Requirements related to the qualification of the service provider and their facilities
The service provision process, from diagnosis and service delivery through to charging
Quality-related requirements for the service to be provided, and verification of the success of treatment or care
Contractual prices for all chargeable services related to the treatment or care

Health insurance companies are able to conclude their own, separately negotiated agreements with potential service providers. It is therefore possible for contractual prices to vary slightly, and not simply according to which health insurance company is used. Differences are even possible between suppliers, which include the Federal Guild of Audiologists (BIHA), as well as companies such as GEERS.

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How much will the health insurance company contribute? | Connect Hearing

Overview:

Requirements for cost coverage by health insurance companies

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Step-by-step guide to cost coverage by health insurance companies

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Care agreements with health insurance companies

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