Yes. Barmer covers the costs for therapeutic treatments prescribed by a doctor. However, you are required to make a statutory co-payment of 10% of the cost of these treatments and an additional 10 euro per prescription. Therapeutic treatments include physiotherapeutic treatments and occupational, voice, speech and language therapies, podiatry therapy for diabetic foot syndrome as well as nutritional therapy for rare metabolic diseases.
You need therapeutic treatments over a long period of time?
The legislator has created regulations on this topic in the so-called Heilmittel-Richtlinie (Therapeutic Products Directive). The regulation specifies the maximum amount of treatment that can be prescribed in a regular case (the so-called "Regelfall"). If the amount of prescribed treatment is not sufficient because of serious and permanent damage to health, a long-term need for therapeutic treatments can be recognized under certain conditions.
There are two diagnosis lists that include the respective serious diagnoses:
Diagnosis list of the "Heilmittel-Richtlinie" | List of special prescription cases |
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Examples: - Chronic rheumatic inflammatory disease of
the joints in childhood - Lymphoedema from stage II
- Paraparesis (incomplete paralysis) and
paraplegia
| Examples: - Multiple sclerosis
- Post-stroke condition (limited to a maximum of
one year after the acute event) - Scoliosis (under certain conditions)
|
If your diagnosis is included in one of the diagnosis lists and other additional conditions are met, the requirements for a longer-term or long-term need for therapeutic treatment are fulfilled. In this case, Barmer does not require any application.
What if my diagnosis is not included in the lists?
If your doctor has diagnosed you with a serious health condition and long-term impairment lasting longer than one year, you can apply to Barmer for the individual approval of a long-term therapeutic treatment requirement.
Please submit the following documents to us for the assessment of your application:
- Your application in free form and
- A copy of the medical prescription with medical justification.
- If available, further medical documents such as hospital reports, medical findings.
We may obtain a neutral expert opinion from the "Medizinische Dienst" (Medical Advisory Service) to review your application. If the requirements for a long-term therapeutic treatment are met, your application will be approved.
If the requirements are not met, you will receive a written rejection, which you should also submit to your doctor. This rejection does not mean that your doctor is no longer allowed to prescribe therapeutic treatments. The doctor can, for example, continue a medically necessary treatment beyond the "orientierende Behandlungsmenge" (indicative treatment quantity).
People with statutory health insurance should always receive medically necessary therapeutic treatment. Exclusion only applies if the doctor determines that the prescription is not economical. This would be the case, for example, if the treatment objective can also be achieved with medical aids, medication or personal measures, taking into account the respective therapy risks – for example, through self-exercise programs, sporting activities or a change in lifestyle. The doctor decides on this in each individual case as part of their therapeutic responsibility.