Pediatricians advocate replacement of the alternative procedure

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Written By Kampretz Bianca

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Berlin The Federal Association of Pediatric and Adolescent Physicians (BVKJ) requests that the replacement procedure be replaced for patients without an electronic health card (eGK). The current procedure causes bureaucracy and uncertainty in practices, explained BVKJ President Michael Hubmann in Mannheim today.

The replacement procedure is mainly used to treat newborns who do not yet have an insurance card. In some federal states, the documents required for the eGK are only issued with a long delay of up to six months.

Practices must then collect the insured child’s name and date of birth, as well as the zip code of the insured child, the insurance company and type of insured, and, if possible, the insurance number. There is currently no alternative to this bureaucratic procedure so that the necessary treatments can be carried out.

Furthermore, this situation is unsatisfactory for practices because if insurance coverage is not clear, they would feel forced to postpone vaccinations and practices cannot be sure that the information is correct.

Above all, the replacement procedure entails a lot of administrative effort, especially if the patient has never come to the office, as the patient’s data is not yet available and the health insurance number and other data cannot be verified.

There are also often problems because health insurance companies often initiate complex verification and reimbursement procedures even in the case of small data deviations, which can occur, for example, when transcribing foreign alphabets.

If the planned contribution-free registration of a child in statutory health insurance fails because the other parent is insured in private health insurance and ultimately earns more than the annual salary limit in the year of registration, replacement procedures would represent a risk. There is even more uncertainty if the child’s paternity status is not later recognized or is incorrect.

It also happened that the parents presented fake insurance cards for themselves. If the appeal is filed months later by the health insurance company supposedly responsible, the account will hardly be able to be settled privately.

Because of all these problems and imponderables, fundamental reform is necessary, demanded Hubmann. However, the substitution procedure cannot be abolished without introducing an alternative billing option.

The BVKJ proposes to oblige health insurers to carry out a simplified insurance check based on the clinic’s birth certificate. There should be a four-week deadline for this.

If the health insurance fund does not issue the insurance confirmation within the deadline, the practice can create a private invoice and the health insurer is then obliged to reimburse the patient for the invoice at a later date.

Alternatively, it is also conceivable to provide interim short-term protection for policyholders with health insurance companies, possibly analogous to promising coverage for other types of insurance, or to allow billing via a parent’s insurance card. In any case, there should be no recourse if parental insurance is presented. © lau/aerzteblatt.de

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