REHABILITATION AFTER MEDICAL PROCEDURES
To receive benefits for medical rehabilitation, you must submit an application to the respective rehabilitation cost carrier. Which cost carrier is ultimately responsible for your rehabilitation application depends on how and with health care insurance you are insured.
If the treating physician or treating hospital requires you to have rehabilitation treatments and/or curative continuing treatments as an inpatient at a rehabilitation hospital or clinic, the treating physician or hospital will make arrangements for you, meaning that within the referral process they will file the application for you. The hospital's social service will be the appropriate point of contact. Since a follow-up treatment / rehabilitation is directly related to a hospital stay, such treatment should begin promptly after the hospital stay. For a continuing treatment after a medical procedure, the patient pays a co-payment of 10 euros per day for max. 28 days. The previous hospital stay will be considered in the billing.
If you have already been discharged from the hospital and you wish to apply for a rehabilitation treatment, you should first ask yourself what results you expect from such a rehabilitation. The answer to this question is an important clue in the conversation with your doctor and the filing of an application for rehabilitation. Is it, for example, to fully recover after an illness or a medical procedure or is it in the forecast that you could possibly become disabled?
Generally, it is important to take the rehabilitation application with a clear goal in this in mind and to discuss this goal with your treating physician, because he or she is ultimately the person to decide about the medical necessity of a rehabilitation program and to support your application with his or her professional opinion.
Application in 3 steps
Go to your treating physician (family doctor) or to the appropriate specialist who is treating you in this specific case. He or she will help you to file the rehabilitation application.
The basis are the physician's report that is established by combining he physician's diagnosis and individual findings. The report is attached to the application of the rehabilitation application.
The completed rehabilitation application, the self-assessment form, and the medical report will be sent to the rehabilitation cost carrier by your physician's office.
Counseling for rehabilitation application
Generally, it is advisable to seek advice or counseling during the application process in addition to the consultation with your physician. Reliable service centers are
- your health insurance
- the relevant statutory pension insurance
- the common service centers for rehabilitation
- the independent patient consultation center (www.unabhaengige-patientenberatung.de)
- the Social Association VdK Germany (www.vdk.de)
- the German Social Association (www.sovd.de)
Your right to select the clinic of your choice
Prior to planning a rehabilitation program, you should inform yourself about which rehabilitation clinic or hostpital treats your condition and what your own expectations are in terms of location, services, and facilities. Important is that the clinic has been certified by an independent regulatory body and accordingly conforms to high, regularly monitored quality standards. The Birkle-Klinik for example is certified according to DIN EN ISO 9001:2008 and the Directives 5.0 of the German Society for Medical Rehabilitation (DEGEMED).
You can complete your application with the request for a clinic suitable to your needs since according to § 8 SGB IX you have the right to choose treatment at a clinic or hospital of your preference. The treatment center, clinic or hospital must be certified and there may not be any medical reasons contrary to the illness requiring the rehabilitation program. A rehabilitation health insurance carrier (e.g. the statutory health insurance) is not entitled to grant your request to select a treatment center of your choice only under the premises that you pay the “difference” between the standard rate and the actual charges.
Such a co-payment is legally not permissible! Costs are based on the performance-benefit principle, meaning that you have the statutory right to have the rehabilitation and the related services paid in full by your health insurance carrier and without having to pay the so-called “differing amount”. Exercise your right to be treated at a clinic or hospital of your choice!
Follow-up treatment (AHB) or continuing rehabilitation (AR)
In many diseases, a follow-up treatment after an acute disease or surgical intervention in a hospital or clinic is necessary and required by the treating physicians (Follow-up treatment - AHB or continuing rehabilitation – AR). For example, patients who have undergone a hip or knee replacement need rehabilitation treatment and/or follow-up therapies. A simplified application process ensures a fast transfer from the hospital to a rehabilitation clinic. The attending physician at the treating hospital can take all the necessary steps. The Social Services Department will also assist you in the application process and organize registration and admission at the Rehab Clinic, if the decision for rehabilitation was made after the patient has left the hospital.
Consecutive follow-up / rehabilitation measures (AGMB)
In contrast to the follow-up treatment (AHB), the German pension retirement (state employees) system speaks about continuing health care measures (AGM) if the patient is not a member of any public health insurance or in case a rehabilitation treatment is not possible for medical or other reasons. For insurance purpose, at an AGM each case is reviewed individually to establish the need for the rehabilitation or continuing treatment. Once the need is established, the insurance carrier will approve the rehab. However, a direct transfer from the discharging hospital to the Rehab Clinic is not possible. A direct transfer from the hospital to a continuing health care facility (AGMB) is also not possible. After a preferred application process by the German pension retirement system, the patient will be referred to the appropriate treatment facility.
In addition, a distinction is made according to the most important rehab. These are
- inpatient or outpatient medical treatment (HV, registration and admission without previous acute hospital care)
- statutory and trade association Next inpatient treatment (BGSW) after occupational accidents at the workplace and on the way to and from the work place
- extended outpatient physiotherapy (EaP) of statutory and trade associations after occupational accidents at the workplace and on the way to and from the work place
Accelerated process for follow-up/rehab treatments
The so-called accelerated process for healing methods are available for patients of the German Pension Insurances (DRV). Here rehabilitation is approved within 14 days after a hospital stay. This applies to insured persons whose earning capacity is substantially threatened or impaired by a medical diagnosis and/or review.
- use the AHB request form (8.7501) and mail it together with the AHB diagnostic reports (8.7502)
- medical services and health services of the hospitals, fill out the application and send it to the rehab facility
- submit the applications with the so-called “red stamp” accelerated rehabilitation process"
- submit application to the AHB address the German Pension Association (DRV) (FAX +49 30 / 865 279 75)
- send original documents by postal mail to the German Pension Association (DRV)
- the decision granting the rehabilitation measures will be issue by the German Pension Association (DRV) shortly after filing the application
Private health insurance (PHI)
Whether or not a private health insurance covers the costs for a rehabilitation or follow-up treatment, depends on the patient/insurance contract. Please check your policy for coverage prior to registering at the Rehab Clinic.
Generally, the cost of a follow-up treatment will be covered by the private health insurance since it is formally treated as a hospital stay. The Birkle-Klinik is authorized to treat PHI as a so-called "mixed health care facility".
Decision and Ojection
According to the socio-medical review and insurance assessment of your application, you will receive a notice from the insurance provider. In case of rejection, you have the opportunity to object in writing within one month. Often, the rehabilitation is approved after you have filed an objection - so do not hesitate to exercise your right to object to the rejection. You have the same rights in the event that you do not agree with the proposed facility. Just ask for an immediate change of registration in the clinic of your choice since your wish for a clinic of your choice must be taken into consideration.
However, the cost carrier determines the type of costs, duration and extent of the treatment, beginning and end of the health measures.