Health insurance plans approve more maternity and mother-child cures
The rejection rate of health insurance companies for mother or mother-child cures has dropped significantly in the past year, according to the mother's recovery agency. "Finally, more mothers can take urgently needed cure measures for prevention or rehabilitation," said the report of the mother recovery center in Berlin.
In the first half of 2011, health insurance companies still rejected 35 percent of applications for mother or mother-child cures. In the first half of 2012, the rejection rate has now dropped to 21 percent, reports the mother's recovery center. This is an extremely positive development for the women concerned, but the proportion of rejected applications still seems relatively high.
Trend reversal in the approval of mother-child cures? In view of the significant decline in the rejection rate for mother cures, the chairwoman of the board of trustees of the mother's recovery center and member of the Bundestag, Marlene Rupprecht, was extremely pleased. "We worked very hard to reverse this trend," said Rupprecht on Thursday in Berlin. Last year, thanks to massive political support, the prospects for overworked and rested mothers had improved significantly. Today, the mothers could "assume that their application for a course measure will be properly checked and decided by the health insurance company," explained the chair of the board of trustees. “16 percent more mothers in the first half of the year are a good start. We expect a further increase, ”said Rupprecht.
Review Report Reveals Significant Defects in Approval Practice The General Manager of the Mothers Recovery Center, Anne Schilling, reported that 73 percent of mothers with rejected applications contradicted in the first half of the year and 65 percent were successful. The high rate of justified contradictions shows "that work on improvements for mothers is not yet over," continued Schilling. A key factor is the introduction of new uniform attestation forms required by the Bundestag, which are still pending. In June 2011, an audit report by the Federal Audit Office uncovered the deficits in the approval practice for maternity cures. This identified massive deficits in the approval practice of the health insurance companies for mother and mother-child cures. Most recently, only 39,000 corresponding course measures were approved by the health insurance companies in 2011. Twelve years earlier (1999), the number was 57,000.
Improvement of the approval practice for maternal cures The most frequent reasons for rejecting the cures were, in the opinion of the health insurance funds, insufficient prior use of outpatient measures and other reasons such as "no connection with the mother-child role", "no medical necessity", "no psychosocial stress situation" or the "profitability imperative". In particular, the significant increases in other reasons for rejection are to be assessed critically here, since they allow a relatively broad interpretation. In order to counteract this inadequate practice when approving the spa, the German Bundestag had decided at the beginning of the year on a specific list of tasks for the GKV umbrella association. In February 2012, a correspondingly adapted new assessment guideline of the GKV medical service came into force, with the aim of improving the approval practice for spa measures for mothers.
More than two million mothers would need a cure According to Marlene Rupprecht, the high rejection rate for mother cures is particularly critical because the mothers often decide relatively late to apply for them anyway. "In the clinics of the mother's recovery center, we can clearly see that mothers tend to think about their health very late," explained the chair of the board of trustees. Rupprecht estimates the number of mothers in Germany who are in need of treatment at a total of around 2.1 million. The mothers should now be explicitly encouraged to request a mother or child cure if they feel exhausted. “I strongly recommend that women contact the advice centers at the charities. These help mothers competently and free of charge in all questions regarding the application and clinic selection, ”said the chairperson of the board of trustees of the mother's recovery center. In the more than 80 clinics of the mother recovery center in Germany, mothers and their children can take appropriate spa measures. There are also numerous private health clinics that work together with the health insurance companies. (fp)
Easier application for mother-child cures
Better opportunities for mother-child cures
Mother-child cures at risk
Health insurers are approving fewer and fewer treatments
Frequent rejection of mother-child cures
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