More and more privately insured persons are dissatisfied with their health insurance. In 2009, the PKV Ombudsman received over 5000 complaints.
(03.06.2010) The PKV ombudsman received around 15 percent more complaints last year. The obhudsman had to resolve around 5015 disputes. In most cases, it was not about increased doctor's fees, but about the payment of necessary services by the private health insurance company (PKV). For example, a private health insurance company refused to cover the costs of accommodating a baby who was accompanying its mother for inpatient treatment. The mother had to take the baby to the hospital because the child was still being breastfed. The father's private health insurance also refused because, in the opinion of the health insurance company, the baby did not require treatment. "The reasoning of both insurers was basically correct, but led to an unsatisfactory result", explains Obhudsmann Dr. Helmut Müller and still found a good solution: both health insurances had to share the costs.
The times for the health insurance companies are getting worse. This is also reflected in the Moral health insurance company when it comes to assuming costs and goodwill regulations. Compared to 2008, the number of complaints has risen by 15 percent to 5015 cases. According to Dr. Müller were only 432 complaints. However, the number of complaints received is still relatively low compared to the 30 million people insured with private health insurance. According to the PKV arbitration board, the complaint rate is just under one percent. However, many issues are either brought to court or not resolved. Most citizens should be satisfied with the negative answer. Müller, on the other hand, does not see the increase as justified by the fact that private health insurers would have to save. Rather, the increased awareness of the arbitration board is responsible for it.
The complaints at a glance: The majority of the complaints were due to full private health insurance. Here the share was 83 percent. In 2008 it was only 78 percent. Around 25 percent of the complaints were successful for the customer. Most of the complaints (22.8 percent) were due to refusal to receive medical services. Complaints based on the doctors' fee schedule were submitted in 13.9 percent of the cases. Because of the general insurance conditions of private health insurers, judgments were made in 10.4% of the cases. Complaints due to the new basic tariff were made in 3.1 percent and due to false claims by insurance representatives in 3.2 percent.
It is the job of men and women to avoid legal disputes through arbitration. However, neither the health insurer nor the insured are bound by the recommendations. Only "recommendations" are given. However, consumers also have the option of filing a complaint with the financial supervisory authority "BaFin". 1,757 customers complained about their private health insurance. (sb)
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