What to say when health insurance calls?
What do I have to tell the health insurance company about my illness?
It is sufficient if those affected provide their health insurance company with information in writing. Information about the exact course of treatment and planned rehabilitation measures only has to be communicated to the medical service of the health insurance companies (MDK).
Do you have to call the health insurance company?
Can the cashier call me? Your health insurance company may only obtain the information from you in writing – digitally or by letter. A telephone call is only an option if you have consented in writing or electronically to a telephone survey.
Which questions do I have to answer for the health insurance company?
Anyone who is on sick leave often receives a “self-disclosure sheet” from their health insurance company with medical and personal questions. Most of the time this is not allowed. For this reason, those affected should under no circumstances make their data available to the health insurer in good faith.
Why is the health insurance company calling me?
Such calls are usually about sick pay: If an employee in Germany falls ill, they usually first receive what is known as continued wages. The employer continues to pay the salary as normal, even though the employee is officially unable to work.
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How do I behave if the health insurance company puts pressure on me?
Because it is not the health insurance company that is responsible for checking your incapacity for work, but the medical service. If the health insurance company still harasses you on the phone, you should reveal as little as possible about yourself. Tell her that you are happy to clarify everything that needs to be done in writing.
What does the health insurance company learn from the doctor?
The law stipulates the transmission of the following data: Services rendered including (encrypted) diagnosis, doctor’s number, insured person’s master data of the electronic health card.
When does health insurance check incapacity for work?
The health insurance companies are legally obliged to have the incapacity to work of insured persons assessed by the medical service when it comes to ensuring the success of the treatment and restoring the ability to work, or. if there are doubts about the inability to work.
Can my insurer force me to go back to work?
The cash register cannot force anyone to go back to work. However, even patients who stay at home with a sick note from their doctor must expect the health insurance company to stop paying sick pay. Then only a written objection helps.
When does the health insurance company turn on the MDK?
The health insurance companies are not only entitled but, if it is necessary due to the type, severity, duration or frequency of the illness or the course of the illness, they are even legally obliged to obtain expert opinions from the MDK in order to eliminate doubts about the inability to work (§ 275 Para. 1 SGB V).
How does MDK check incapacity for work?
The MD carries out the incapacity assessment either on the basis of the files or through a personal physical assessment. If a physical examination is necessary, MD Bayern will invite you to the nearest counseling and assessment center.
What can I do if I am mentally ill?
These include, for example, swimming, water aerobics or special exercises in the fitness studio. Hiking and physical activity can be helpful for psychological complaints such as sick leave for burnout or depression.
How long can my family doctor write me off sick for depression?
If the depression is treated in a general clinic, employees can be given a neutral AU. In this way, the employer does not know in which ward the treatment is taking place. Employees can be sick six weeks a year without fear of losing their job.
Can the MDK just write me healthy?
Workers get sick, sometimes for a long time. Don’t you wish for spontaneous healing? The medical service of the health insurance companies (MDK) makes it possible!
Can the health insurance company cancel my sick pay?
If you receive other benefits such as unemployment benefit or parental benefit, the entitlement to sickness benefit can be suspended; if you receive different pensions, the entitlement can be reduced. For example, there is no entitlement to sick pay after 78 weeks have elapsed;
How long does health insurance pay for mental illness?
The duration of sick pay is limited. The insured person receives wage replacement for a maximum of 78 weeks in total for the same illness within a period of three years.
How far away can you drive if you are on sick leave?
There is a simple rule that points in the right direction in individual cases: A sick employee must behave in such a way that he or she gets well again as soon as possible. In principle, everything is allowed that does not delay or endanger recovery.
How long can you be on sick leave with burnout?
Furthermore, you don’t have to be afraid of losing your job because of a burnout. Employees can be sick for up to six weeks a year without the risk of being fired. According to German labor law, long-term sick people are provided with continued wages and sick pay for a year and a half.
What is the MDK not allowed to ask?
Of course, the MDK assessment and thus also the questions about the MDK assessment relate to your relatives in many cases. Due to better legibility, we have refrained from using phrases such as «Do you / your relatives…» in the questions on the MDK assessment.
What does the MDK ask on the phone?
behavior and psychological problems. Self-sufficiency. Coping with and dealing independently with the demands and burdens caused by illness or therapy. Organization of everyday life and social contacts.
What does the medical service of the health insurance company ask?
They will ask you about your limitations, problems and need for support in your everyday life using a set list of questions. In the assessment, independence and skills in 6 areas of life, so-called modules, are checked and recorded: Mobility. behavior and psychological problems.
Are diagnoses sent to the health insurance company?
This defines within a very limited framework what information the health insurance companies are allowed to receive. Incidentally, it is precisely regulated who may ask such questions. For example, health insurance companies are not allowed to receive any detailed information about diagnoses and medical treatment measures, or about findings.
When does health insurance delete diagnoses?
Services provided by the doctor, which serve to check the prerequisite for the granting of services (§ 292 SGB V), are deleted after 10 years (§ 304, paragraph 1, sentence 1). Illness diagnoses as part of the determination of incapacity for work belong to this category.
Can you see on the health insurance card which doctor you have been to?
Ministry: Patients decide on insight
A spokesman for the Federal Ministry of Health now emphasized: «The patient can decide which doctor to give insight into the electronic patient file.» With the patient’s consent, the doctor then has access to all the data.
Can the health insurance company demand reintegration?
Within 14 days after the end of the rehabilitation measure, the health insurance company can also suggest a gradual reintegration if there has been a change in the points on the checklist.
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