Medical gaps do not justify going to the podiatrist
Health insured persons can only have an ingrown toenail treated at the doctor's expense at the doctor's expense, even if they cannot find a doctor for this. As it is a medical benefit, the statutory health insurance companies are not allowed to reimburse the treatment costs with a qualified medical pedicure, judged on Tuesday, December 18, 2018, the Federal Social Court (BSG) in Kassel (file number: B 1 KR 34/17 R ).
This means that a Berliner stays on the treatment costs with a podiatrist. She had tried in vain to find a doctor who was ready to treat her chronically ingrown toenail. Then she went to a medical podiatrist. The woman treated these with an individually adapted wire toenail clip.
The Berliner wanted to have the costs reimbursed by her health insurance. The podiatrist was also sufficiently qualified.
The plaintiff's health insurance fund paid the material costs, but not the treatment costs for the podiatrist in the amount of 152 euros. This is a medical benefit that only doctors are allowed to provide on cash benefits. The health insurance fund admitted that doctors do not provide this therapy “across the board”, especially since it is not taught in medical training either. However, the legal provisions are clear.
The State Social Court of Berlin-Brandenburg awarded the applicant the reimbursement of costs. There is a "system failure" here. She was entitled to treatment, but no doctor was willing to provide it. In such a case, the health insurance company must also reimburse the treatment costs to the podiatrist.
But the BSG overturned this decision. This is "a service reserved for the doctor". The fact that the plaintiff was unable to find any doctors to treat her medical foot problem does not justify a claim for reimbursement for the work performed independently by the podiatrist. If necessary, the woman could have carried out the treatment at a private doctor and then reimbursed the costs from the cash register.
The only exception is diabetic foot syndrome. Here, podiatrists are exceptionally allowed to treat them independently at the till costs. fle / mwo