Frequent reasons for rejection by the health insurance company
With a good argument, an opposition to a rejected application for medical aids is often successful. To help you argue against frequent reasons for rejection by health insurance companies, we have compiled judgements on this page that have gone in favor of the insured person.
Reasons for rejection, counterarguments and judgements
No GBA recommendation yet
Reason for rejection
The Federal Joint Committee has not yet issued a recommendation on the novel assistive products.
Counterargument
The assistive product is neither a treatment method in itself, nor is it used in combination with a new treatment method. It is used solely to compensate for disability; therefore, the assistive products do not require a GBA recommendation.
No evidence-based studies yet
Reason for rejection
No evidence-based studies are yet available on the assistive products.
Counterargument
The assistive products have a CE mark and can therefore be considered suitable and assured in principle.
No claim to further technical development
Reason for refusal
The insured person is already provided with high-quality assistive products and is not entitled to further technical development.
Counter-argument
As long as the disability has not been fully compensated in the sense of equalization with a non-disabled person, the person concerned is entitled to better, higher-quality benefits that correspond to the current state of medical technology.
No complete disability compensation
Reason for refusal
The assistive products do not fully compensate for the existing disability (paraplegia).
Counter-argument
It is not necessary to fully compensate for the almost unlimited possibilities of non-disabled people. It is sufficient if the lost physical function is only partially compensated.
Already supplying high-quality assistive products
Reason for refusal
The insured person is already provided with a high-quality wheelchair; this enables them to travel even further distances than with an exoskeleton.
Counter-argument
A wheelchair only indirectly compensates for the disability, whereas an exoskeleton directly compensates for the disability. Seated locomotion is no substitute for the basic needs of standing and walking.
Useful life is limited
Reason for refusal
The period of use is limited to a few hours a day due to the severity of the disability.
Counter-argument
Upright, self-determined walking involves a comprehensible major gain in movement, which can potentially have an impact in all areas of daily life.
Inefficiency
Reason for refusal
The assistive products are uneconomical.
Counter-argument
The cost-effectiveness of an assistive product for the direct compensation of disabilities is generally to be assumed. It should only be checked if there are several products that are functionally equally suitable.