How do I stop expecting rejection
Social Association VdK Saxony e.V.
On the way to the hearing aid
The following applies to hearing aid care: the health insurance companies pay flat-rate fixed amounts; currently this is EUR 784.94 including VAT for insured persons with hearing loss who have reached the age of 18.
The Federal Social Court decided, however, that this does not exempt the health insurers from the obligation to compensate for the hearing impairment (judgment of December 17, 2009). This means that patients are entitled to a hearing aid that "allows the best possible adjustment to the hearing ability of healthy people according to the state of medical technology, provided that this offers a considerable benefit in everyday life". As far as technically possible, this also includes listening and understanding in larger rooms and with disturbing ambient noises and not just one-on-one conversations. So if the fixed amount is not enough, the cash register also has to pay for a more expensive hearing aid.
Here you will find all the steps on the way to a new hearing aid at a glance:
1. Visit your ear, nose and throat (ENT) doctor first!
Your ENT doctor will give you a thorough examination, determine your degree of hearing loss and prescribe you a hearing aid. This regulation is the basis for the supply. Get a doctor's certificate clearly stating the degree of hearing loss and any other reasons for prescribing a hearing aid. Make a copy of the regulation for your records.
Have an audiogram done by your doctor so that you can get price information in acoustic stores at no additional cost. Some ENT doctors also offer hearing aids themselves as part of the shortened supply route. Get an offer, but don't be caught off guard.
2. Visit your hearing care professional!
Visit a hearing care professional with the prescription and the audiogram. The health insurance companies and the hearing aid acousticians have concluded supply contracts which oblige the acousticians to have at least one device ready for a fixed amount, i.e. without the insured person having to pay an own contribution (apart from the statutory additional payment of 10 euros). You can also visit different audiologists and compare prices before starting the adaptation test.
If you can find adequate hearing aids at a fixed price, you will save yourself a lot of hassle and red tape. Based on the regulation, the acoustician will suggest several devices that you can test for free. You should keep a hearing diary and note exactly in which situation you were able to hear how well with which device. You can also change the acoustician after the adaptation test, who will then receive a cancellation fee from the health insurance company. Remember, however, that not only the price but also good service is important for good hearing aid supply.
If the fixed amount of the device is not sufficient to compensate for your individual hearing impairment and you have to choose a more expensive one, you can apply to your health insurance company to cover the costs. Note that amenities such as better wearing comfort or less conspicuous hearing aids are not part of the disability compensation. If you opt for a more expensive hearing aid for these reasons, you will have to bear the additional costs yourself.
This process can be lengthy and complicated, so consider the following steps:
3. Submit an application for reimbursement
Have your hearing care professional write you an opinion explaining why only the selected, more expensive device can compensate for your hearing impairment. The deficits, especially of the fixed-price devices, should be discussed in detail. Your hearing diary can be of great help here.
Submit the report to your health insurance company together with the cost estimate for the required model and an informal written application for assumption of the costs for the selected hearing aid and have your receipt confirmed.
Now there are three options:
a) The health insurance company approves the assumption of costs, then everything is clarified for you and all you have to do is pick up your hearing aid and have it fine-tuned.
b) The health insurance company rejects your application, then file an objection (see 4a).
c) The cash register does not react at all. Then set a deadline (see 4b).
4a) File an objection!
If the health insurance company rejects your application for the assumption of costs and for the required hearing aid, you must object to this decision informally and in writing within one month. Enclose the medical certificate from your ENT doctor as well as the adaptation test as well as the report from the hearing aid acoustician and, if necessary, your hearing diary (all in copy!) And ask your health insurance company to draw up an opinion from the MDK (Medical Service of the Health Insurance Companies). The creation of this MDK report on your case is free of charge for you and the health insurance fund is obliged, according to the principle of official investigation, to also medically check your application before it finally rejects it! After a final rejection, you still have to take the action before the social court.
It is important that the fund sends a written rejection. When the cash register calls you, insist on a written notification.
4b) Set a deadline
From January 1st, the health insurance company must respond to you within three weeks if it has commissioned an expert opinion from the MDK within five weeks. Instead of a decision, the answer can also contain reasons why the deadline is exceeded. If there is no answer within the deadline, or the reasons are insufficient, you can set a deadline for the health insurance company, after which you can buy the hearing aid yourself; the health insurance company must then pay the costs (Section 13, Paragraph 3a of the Social Code Book V). An informal letter is sufficient; two weeks are appropriate as a deadline. If the health insurance company has still not made a decision after the deadline, buy the selected hearing aid and submit the invoice to the health insurance company for reimbursement. If you receive a rejection notice, file an objection (see 4a).
Both the contradiction solution and the assumption of costs have their pitfalls. In the first case, you will not receive a hearing aid while the (court) proceedings are ongoing. In the second case, you may be left with the additional costs if appraisers determine in court proceedings that your hearing aid does not have a "significant" advantage over the fixed-price device.
In any case, you should not buy a hearing aid before you have clarified the costs with the cash register, as you would then lose all entitlement. So either wait for the rejection notice, or if it does not come, set a deadline and wait until it has passed.
5. Caution: declaration of additional costs!
Often you should sign a form with the hearing aid acoustician that you have voluntarily opted for this hearing aid, knowing full well that it is above the fixed amount of the health insurance company. Without this form, your application will not be processed by the health insurance company as "incomplete", but with the form you assign your right to reimbursement. Delete the relevant sentences and sign the form. In more recent forms, reasons should be ticked as to why you decided on a device above the fixed amount. Add a new box here indicating a medical reason, for example "Language understanding in large groups of people".
Do not worry too much about this form, if it comes to legal proceedings, the health insurance company will probably not use it, as it is unclear whether this waiver is immoral. In any case, only sign the declaration of additional costs after receiving the rejection notice from the health insurance fund.
6. Make an appointment at your local VdK office!
If your objection is unsuccessful, please contact a VdK advice center near you for further legal examination and legal representation:
Sample applications are available for download on this page:
The local VdK offices will be happy to answer any questions you may have.
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