Hospital treatment; information on the assumption of costs

As an insured person, you are entitled to hospital treatment. Treatment is provided on a full inpatient basis if the treatment objective cannot be achieved by partial, pre-hospital or post-hospital treatment or outpatient treatment including home nursing care.

Description

Insured persons are entitled to treatment in an approved hospital. The benefit includes, in particular, medical treatment, nursing care, provision of medicines, remedies and aids as well as accommodation and meals. Hospital treatment also includes discharge management to support you in securing further care after hospital discharge. To this end, hospital doctors can prescribe medicines and, for a period of up to seven days, among other things, dressings, remedies and aids and home nursing care, as well as determining incapacity for work.

Prerequisites

For inpatient hospital treatment, the principle of "outpatient before inpatient" applies. Insured persons are thus only entitled to full inpatient treatment in an approved hospital if the treatment objective cannot be achieved by partial, pre- or post-inpatient or outpatient treatment including home nursing care.

Procedure

You should discuss whether hospital treatment is necessary with your attending doctor. This can be your family doctor or a specialist. If there is no emergency, you will need a hospital referral from your treating doctor (GP or specialist) to be admitted to hospital. As a rule, you do not need to contact your health insurance fund in advance in order to be admitted to hospital.

Deadlines

none

Required documents

  • Required Documents

    If there is no emergency, you need a hospital referral from your attending physician (general practitioner or specialist) to be admitted to a hospital.

Fees

  • Insured persons who have reached the age of 18 pay 10 euros per calendar day to the hospital from the beginning of the full inpatient hospital treatment within a calendar year for a maximum of 28 days. If, without compelling reason, insured persons choose a hospital other than one named in the medical referral, they may also be charged for all or part of the additional costs.

Remedy

If the health insurance company refuses to pay the benefit, you can lodge an objection. If the objection is not upheld, you can take legal action against it before the social court.

Links to more information

Status: 21.04.2022

Responsible for editing: Niedersächsisches Ministerium für Soziales, Gesundheit und Gleichstellung

  • Online transactions, Bavaria-wide
  • Online transactions, locally limited
  • Prefillable Form, Bavaria-wide
  • Legal bases, Bavaria-wide
  • Legal bases, locally limited
  • Fees, Bavaria-wide
  • Fees, locally limited
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