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Aktuelle Seite: Home \ Patienteninfos \ WER zahlt WAS ?

WER zahlt WAS ?

 

Wer muss eigentlich was bezahlen? Dazu zeigen wir Ihnen einmal, welche Verträge und somit Leistungs- und Zahlungsverpflichtungen bestehen:

Zwischen der privaten Krankenversicherung (PKV) und dem Heilmittelerbringer/ Therapeuten gibt es keine vertraglichen Vereinbarungen. Das bedeutet, die Private Krankenversicherungen und unsere Praxis sind, anders als dies bei der gesetzlichen Krankenversicherung der Fall ist, zu keinem Zeitpunkt direkte Vertragspartner.

Ein Vertragsverhältnis besteht zwischen Patienten und Leistungserbringern über die Kostenhöhe z.B. in Form einer Honorarvereinbarung einerseits und zwischen dem Patienten und seiner PKV über die Kostenübernahme gem. Versicherungstarif andererseits.

Eine definierte Leistungsbeschreibung, die Dauer, konkreten Inhalt und Umfang der Therapie genau festlegt, gibt es im Bereich der PKV mangels vertraglicher Bindung zwischen PKV und Therapeuten nicht. So muss letztlich der Patient entscheiden, welche Therapiequalität er benötigt, um seine gesundheitlichen Probleme zu therapieren. (Übrigens: Die Gerichte entscheiden immer wieder, dass der Privatpatient nicht den billigsten Anbieter wählen muss, um einen Anspruch auf Erstattung zu haben!)

Zwischen Therapiepraxis und Privatpatient wird ein Behandlungsvertrag abgeschlossen (Dienstvertrag gem. §611ff.BGB): Der Heilmittelerbringer verpflichtet sich darin, seine definierte therapeutische Leistung zu erbringen; der Patient verpflichtet sich, dem Therapeuten den vereinbarten Preis für die erbrachte Leistung unabhängig von der Erstattung durch die PKV zu zahlen.

Der Privatpatient hat mit seiner privaten Krankenversicherung einen Vertrag abgeschlossen, aufgrund dessen die Heilmittelkosten übernommen werden. Die vertraglich festgelegten Voraussetzungen zur Kostenerstattung der erbrachten Leistungen durch die private Krankenkasse sind:

  1. Eine ärztliche Verordnung, aus der die Indikation zur Heilmitteltherapie ersichtlich wird und
  2. Die Leistungserbringung durch einen Therapeuten, der gem. Gesetz eine entsprechende Berufsbezeichnung* führen darf. (*Masseur- und Physiotherapeutengesetz (MphG), Ergotherapeutengesetz (ErgThG), Gesetz über den Beruf des Logopäden (LogopG), Podologengesetz (PodG))

Privat Versicherte müssen darauf achten, dass der Vertrag keine Klausel enthält, der die Kostenerstattung für Heilmittel der Höhe nach begrenzt!

 

Letzte Änderung am Freitag, 16 Mai 2014 06:47
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