Home Health Insurance in Saxony-Anhalt Erroneously Denies Home Care Services
In a recent case, a consumer in Saxony-Anhalt was left perplexed when their health insurance company refused to cover the costs of compression stockings, assuming that they had a caregiver living with them. However, the consumer lives alone and their caregiver does not reside with them.
This scenario raises questions about the criteria for home healthcare coverage and who qualifies as a caregiver. According to the Consumer Advice Center Saxony-Anhalt, it is not legally required that the caregiver, as defined by the eleventh Social Code Book, lives with the person in need of care.
Home healthcare encompasses a range of services, including basic and treatment care, as well as household support in individual cases. It is required when hospital treatment is not possible, or when it can be avoided or shortened through home healthcare. Wearing compression stockings can be covered by health insurance if necessary due to a medical diagnosis and is considered home healthcare.
Josefine Pönicke, a representative of the Consumer Advice Center Saxony-Anhalt, explained that a caregiver who does not live with the person in need of care is not automatically considered a person living in the household. The search results do not contain information about the name of the insurance that denied the claim for home care benefits of the mentioned consumer.
It is essential to note that, according to § 37 (3) SGB V, a caregiver can fulfill the conditions for denial of service if they live with the person receiving care. However, this does not mean that a caregiver who does not live with the person in need of care is automatically disqualified from providing necessary care.
The case serves as a reminder for consumers to understand their rights and the criteria for home healthcare coverage. If you find yourself in a similar situation, it is recommended to seek advice from a consumer advice centre or legal expert to ensure you receive the care and coverage you are entitled to.
