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Frequent reasons for rejection by the health insurance company

The care process can be long and arduous. You don't always get the assistive products you want. Under certain circumstances, the service providers reject the application.

However, an opposition often leads to success. To do so, it is important to understand the arguments used by the service provider. Find out here what are the common reasons for the rejection of assistive products and which judgements have been made in favor of the claimants in legal proceedings.

Reasons for rejection

The GBA has not yet issued a recommendation on the novel assistive products.

The assistive products is neither a treatment method per se, nor is it used in combination with a new treatment method. It serves solely to compensate for disability; therefore, the assistive products do not require a GBA recommendation.

No evidence-based studies are yet available on the assistive products.

The assistive products have a CE mark and are therefore considered fundamentally suitable and safe.

The insured person is already provided with a high-quality assistive product and is not entitled to further technical development.

As long as the compensation of the disability is not completely achieved in the sense of equalization with a non-disabled person, the affected person is entitled to better, higher-quality services corresponding to the current state of medical technology!

The assistive products do not completely compensate for the existing disability (paraplegia).

A complete equalization with the almost unlimited possibilities of non-disabled people is not required; it is sufficient if the failed body function is compensated even partially.

The insured person is already provided with a high-quality wheelchair; this enables him to travel even further distances than with an exoskeleton.

A wheelchair only ensures indirect compensation of the disability, whereas an exoskeleton brings about direct compensation of the disability. A seated locomotion is no substitute for the basic needs of standing and walking.

Due to the severity of the disability, the duration of use is limited to a few hours per day.

Upright, self-directed walking involves a comprehensible large gain in movement that can potentially affect all areas of daily life.

The assistive products are uneconomical.

The cost-effectiveness of an assistive product for the direct compensation of disabilities is to be assumed in principle. It is only to be checked if there are several functionally equally suitable products.

Other judgements