Patient transportation prescription: when health insurance companies cover your travel costs Patient transportation can be prescribed by a doctor, which means that statutory health insurance companies cover the travel costs. When does this apply to you? Image description 2 men are behind a vehicle with the doors open. One of the men is in a wheelchair and is being pushed by the other man. Medical prescription — new regulations Since October 1, 2020, there have been new regulations for patient transportation. Transportation can be prescribed if the journey is medically necessary. But what conditions must be met for a journey to be considered medically necessary? The doctor determines that it is not possible to travel independently, e.g. by car or bus A medical measure takes place at the place of treatment (massages, preliminary examinations or picking up prescriptions do not count) The journey must take a direct route from the patient’s place of residence (e.g. home, accident site, care facility) to the appropriate treatment facility However, it is legally not intended for health insurance companies to cover the travel costs. In the following, it is important to determine whether inpatient or outpatient treatment is to be provided. Differences in the prescription of patient transportation Inpatient treatment vs. outpatient treatment Image description Left picture: A woman lies in a hospital bed and is served food by a nurse. Right picture: A woman is on her way out of the room. A doctor stands in the doorway and lets the woman walk past him. Inpatient treatment exists if patients spend at least one day and one night at the place of treatment Ordering of patient transportation by doctors if medically necessary (health insurance companies cover the costs) Approval from the health insurance fund is not required (no approval required) Outpatient treatment exists if patients are allowed to leave the place of treatment immediately after treatment No prescription of patient transportation by doctors possible (health insurance companies generally do not cover any costs) Regulations possible in exceptional cases Outpatient treatment: exceptional cases requiring authorization Approval requirement = prescription for the trip must be submitted to the health insurance company in advance Patients who require high-frequency treatment over a longer period of time (dialysis treatment, radiotherapy or chemotherapy)</li Patients who require transportation due to their state of health (e.g. infectious disease) Image description Close-up of a desk: A person (left) hands a document to another person (right). Outpatient treatment: exceptional cases without the need for authorization without approval requirement = prescription for the trip does not have to be submitted to the health insurance company in advance Patients undergoing outpatient surgery (inpatient stay is avoided/shortened as a result)</li Patients who are restricted in their mobility Care level 3 (if the patient also has limited mobility) Care level 4, care level 5 People with severe disabilities (mark “aG”, “BI” or “H What means of transportation are available? A distinction can be made between 3 different means of transportation: Patient transport vehicles, classic ambulances or emergency ambulances and vehicles for patient transportation. These include public transportation or rental cars and cabs that are equipped for the disabled (e.g. wheelchair cabs). Image description A man pushes another man, who is in a wheelchair, into a wheelchair cab. Specially equipped vehicles, such as the wheelchair taxi, are used to carry out patient journeys. Trips with private motor vehicles, rental cars or public transportation are also counted as patient journeys. Compared to patient transportation with patient transport vehicles, no medical care is provided during the journey. Image description Picture of an ambulance Patient transport vehicles are used for transporting patients. This means of transport is suitable if patients require specialist medical care or special equipment in the vehicle during the journey. Image description Picture of an emergency ambulance A classic emergency doctor or ambulance is used to carry out rescue journeys. This also includes rescue helicopters. If patients require special equipment or are in a critical medical condition, this means of transport is suitable. Am I entitled to all means of transportation? When it comes to choosing the most suitable means of transportation, it no longer matters whether the patient is an inpatient or outpatient. However, the choice of means of transport depends on the following points: individual needs of the patient (is medical care possibly required?) Analysis of doctors for the most suitable means of transportation Health insurance companies (can carry out an assessment) Additional payment for transportation costs If journeys are covered by health insurance, insured persons are unfortunately still obliged to pay part of the costs of each journey themselves. This also applies to children and young people. What you need to know about payment: Pay 10% of the travel costs per journey (minimum five euros and maximum ten euros per journey) Drivers receive the money immediately after transportation If the burden limit according to § 62 SGB is exceeded, insured persons can exempt themselves from the payments 2% of the gross income 1% of gross income for the chronically ill (if the illness requires long-term treatment) Image description 6 dice with various symbols from the health sector are arranged in a pyramid. The top die is turned by a person and is the only die to show 2 symbols (hospital cross and money coins). We hope we have been able to provide you with a lot of interesting and important information about prescriptions for patient transportation. If you have any further questions, please contact a doctor or your health insurance company. You can also follow us on LinkedIn!
