New German legislation continues to allow for higher quality products Keep written records of consultations about additional costs
A new German law on improving the provision of therapeutic and medical aids entered into force in spring. Known by the acronym HHVG, it continues to allow for the provision of higher quality products partly financed by patient contributions. However, as explained by Munich-based attorney Dr. Dirk Usadel , the practicalities of the new law are not always easy for those affected to grasp.
“One issue that often causes problems during the everyday provision of products is pricing. Medical supply retailers receive a fixed sum from health insurance companies for supplying aids from a specific group (product type). This sum is generally in the form of a mixed price or average price, and is used to determine the price of all the individual products in the product type group in question. In turn, insured parties often assume that the service provider is obligated to provide the aid to them for this price and that their financial contribution is therefore limited to the customary additional payment. However, in reality, medical supply retailers do not always have to make do with the sum reimbursed to them by the health insurance company. If the insured party decides they would like a higher quality product that is more expensive than the fixed sum stipulated by the health insurer, the medical supply retailer may ask the patient to pay a surcharge. The product quality may be higher in terms of design, feel , durability, elaborate workmanship, special fit , or easy maintenance, to name just a few.
Comprehensive information is mandatory
The HHVG continues to allow higher quality treatments to be supplied, provided that the additional sum is invoiced to the insured party. In detail – with the exception of specific regulations that apply in a few isolated cases – products are supplied as follows: The physician identifies the patient’s medical needs and writes a prescription specifying the required product type using the German Medical Aids Directory or the corresponding seven-digit reference number. As far as possible, the medical supply retailer allows the customer to choose from the entire range of individual products belonging to the product type. The customer must be shown and allowed to try on at least one surcharge-free aid.
If, after receiving expert advice, the customer chooses a higher quality aid for which a surcharge is due, the seller must issue a written document stating the surcharge amount and must ask the buyer to confirm this amount in writing.
Keep all documentation
If the new legislation has not yet been included in the supply agreements concluded with the health insurance companies, medical supply retailers must continue operating in accordance with their current agreements in terms of the advice they provide and its documentation. In any case, it is nevertheless essential that medical supply retailers keep all documents relating to their patient consultations. Once the statutory health insurance providers have put the necessary technical requirements in place, the documentation created to inform customers of the additional costs must be appended to the bill.”