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Frequent reasons for refusal by the health insurance company

The supply process can be long and arduous. You do not always get the aid you want. Under certain circumstances, the service providers reject the motion and oppisition.

However, an objection often leads to success. To do this, it is important to understand the argumentation of the service provider. Find out here what are the common reasons for the rejection of an aid and which judgement in a lawsuit has been in favour of the claimant.

Reasons for refusal

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

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

No evidence-based studies are yet available on the device.

The device has a CE mark and is therefore considered fundamentally suitable and safe.

The insured person is already provided BGG a high-quality aid and is not entitled to further technical development.

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

The aid does not completely compensate for the existing disability (paraplegia).

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

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

A wheelchair only provides indirect compensation for the disability, whereas an exoskeleton directly compensates for 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-determined walking involves a comprehensible large gain in movement, which can potentially have an effect in all areas of daily life.

The aid is uneconomical.

The economic viability of an assistive device for the direct compensation of disabilities is to be assumed in principle. It is only to be checked if there are several products that are functionally equally suitable.

Other judgments