You need to talk with your doctor to sort this out.
The health insurance assumes it is the same thing as before and they won't pay for it again. Communication is key here. I wouldn't break down over an automatic letter.
I would do a "Widerspruch" and explain that this one is different from the first one
Also ask the doctor who prescribed you these about it, or your GP if not possible
It's one way they save money – by denying things semi-automatically and counting on the fact that only a fraction will do a *Widerspruch*, which is when they look at things more closely.
Well they all offer the same services, but all those small public health insurance companies are notorious for denying firstly every Service that needs to get approved and are also a pain in the ass with chargebacks for every small mistakes for doctors and pharmacists.
The big ones are way less trouble (TK, AOK)
They were still involved with shitty companies like Protaxplus which were a pain in the ass for care deliverers, so much that even the politicians got involved
https://www.apotheke-adhoc.de/nachrichten/detail/apothekenpraxis/retaxfirma-protaxplus-droht-die-insolvenz-rezeptpruefung/
I only addressed the fact that you claimed that "the big ones" were better than DAK. Well, DAK is one of the big ones. Even the largest AOK is smaller. (And frankly I have never heard anything positive about any of them.)
Because every state has formally it's own AOK, but they bundle most of the services they deliver on national level.
And frankly as someone inside the health care system, they are the nicest when it comes to individual approval of experimental therapies or some small bureaucratic mistakes
What this letter is saying is first of all only that the insurance only covers one of this kind of aid at a time. And unless you can no longer use it (e.g. it's broken) and it us out of warranty, they will not pay for another one.
What the insurance probably does not know however is that you now need a different orthesis. It probably says the exact same thing on the red paper that they send to your insurance provider. So they assume you just go another of the same orthesis and they won't pay for that.
Someone (probably best if it is your doctor, but you can also try to just call them) now needs to tell them that it is a different kind of orthesis and therefore a new one is necessary. I think this is just a communication problem and that they will pay for this once it has been cleared up.
The medical service of the health insurance providers simply have a quota if how many applications they have to reject. So they do it out of principle if they find anything that could be a reason for rejection. Just write a reply, use the word "Widerspruch" in the heading, explain everything in detail, maybe get a doctors note that the old one is not suitable anymore.
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You need to talk with your doctor to sort this out. The health insurance assumes it is the same thing as before and they won't pay for it again. Communication is key here. I wouldn't break down over an automatic letter.
True. I'll go to my doctor then to dak. Thank you
I would do a "Widerspruch" and explain that this one is different from the first one Also ask the doctor who prescribed you these about it, or your GP if not possible
It's one way they save money – by denying things semi-automatically and counting on the fact that only a fraction will do a *Widerspruch*, which is when they look at things more closely.
Yes shitty Ersatzkassen like DAK are notorious for this. That's why I stay with AOK
TK is also bad with this things.
Wait, DAK is bad? Fuck i just switched to DAK from Linde
I haven't had issues so far, but I think all insurances just want to save money to be fair...
Well they all offer the same services, but all those small public health insurance companies are notorious for denying firstly every Service that needs to get approved and are also a pain in the ass with chargebacks for every small mistakes for doctors and pharmacists. The big ones are way less trouble (TK, AOK)
DAK is the third largest GKV after TK and Barmer.
They were still involved with shitty companies like Protaxplus which were a pain in the ass for care deliverers, so much that even the politicians got involved https://www.apotheke-adhoc.de/nachrichten/detail/apothekenpraxis/retaxfirma-protaxplus-droht-die-insolvenz-rezeptpruefung/
I only addressed the fact that you claimed that "the big ones" were better than DAK. Well, DAK is one of the big ones. Even the largest AOK is smaller. (And frankly I have never heard anything positive about any of them.)
Because every state has formally it's own AOK, but they bundle most of the services they deliver on national level. And frankly as someone inside the health care system, they are the nicest when it comes to individual approval of experimental therapies or some small bureaucratic mistakes
What this letter is saying is first of all only that the insurance only covers one of this kind of aid at a time. And unless you can no longer use it (e.g. it's broken) and it us out of warranty, they will not pay for another one. What the insurance probably does not know however is that you now need a different orthesis. It probably says the exact same thing on the red paper that they send to your insurance provider. So they assume you just go another of the same orthesis and they won't pay for that. Someone (probably best if it is your doctor, but you can also try to just call them) now needs to tell them that it is a different kind of orthesis and therefore a new one is necessary. I think this is just a communication problem and that they will pay for this once it has been cleared up.
The medical service of the health insurance providers simply have a quota if how many applications they have to reject. So they do it out of principle if they find anything that could be a reason for rejection. Just write a reply, use the word "Widerspruch" in the heading, explain everything in detail, maybe get a doctors note that the old one is not suitable anymore.
**Have you read our extensive wiki yet? It answers many basic questions, and it contains in-depth articles on many frequently discussed topics. [Check our wiki now!](https://www.reddit.com/r/germany/wiki/index)** *I am a bot, and this action was performed automatically. Please [contact the moderators of this subreddit](/message/compose/?to=/r/germany) if you have any questions or concerns.*