If the health insurance doesn't pay -
How to find alternative ways to finance medical aids

You've tried everything - submitted an application, lodged an objection, added documents - and still the medical aid for your child has been rejected? That doesn't mean you have to be stuck with the costs. There are various alternative ways of funding that you can look into - from state support and social services to foundations or fundraising campaigns.

Note: This article does not replace legal advice. We will give you practical tips on who you can turn to if aids are not (fully) covered.

 

1. social welfare office: help with participation and integration assistance


If your child has a disability or a potential disability, the social welfare office can finance aids that enable participation in social life. This is done via so-called integration assistance in accordance with SGB IX.

When does integration assistance apply?

Integration assistance is intended to help people with disabilities to live as independently as possible and participate in everyday life - for example in school, leisure, communication, exercise or social contacts. Aids are included if they are necessary for this.

Typical examples:

  • Special wheelchair for school attendance
  • Communication aids (e.g. talker or tablet with speech app)
  • Therapy bikes or standing trainers
  • Adapted seating systems for school or leisure activities

👉 Important: The aid does not have to be medically necessary (that would be the responsibility of the health insurance company), but must be used for social or educational participation.


Prerequisites

  1. There is an (imminent) physical, mental or psychological disability
  2. Participation in life in the community is restricted
  3. The aid is suitable and necessary to compensate for this restriction

💡 Tip: It is sufficient if the impairment is permanent or is to be expected - e.g. in the case of developmental disorders, muscle diseases or autism.


Will my income be checked?

  • In the case of underage children who live at home, parents are usually not financially responsible.
  • An income and assets check is usually only carried out for adults or inpatients.

This means that parents' income is not usually an obstacle to children receiving assistance.


How to make an application

  1. Find the responsible office: Social welfare office or office for social services at your place of residence
  2. Informal application: "I hereby apply for integration assistance for my child [name, date of birth] to finance the assistive device [name]."
  3. Enclose justification: Why is the aid necessary?
  4. Submit documents: Medical reports, therapy reports, cost estimate, rejection from health insurance company if applicable

💡 Tip: The EUTB (supplementary independent participation advice) provides free support with the application.


Procedure

  • Examination of the requirements
  • Assessment of the suitability of the aid
  • Clarification of whether other cost bearers are primarily responsible

After a few weeks, you will receive a notice of assumption of costs or a pro rata grant.

 

 

2. youth welfare office: help for children and young people


In the case of mental or psychological impairments, the Youth Welfare Office may be responsible. The legal basis is § 35a SGB VIII.

When is the youth welfare office responsible?

  • The child is under 18 years old
  • There is an (impending) mental disability (e.g. autism, ADHD, anxiety disorders)
  • Participation in school, leisure activities or social contacts is restricted

Possible aids:

  • Communication aids
  • Learning and support software
  • Aids to promote social participation

Requirements & proof

  • Medical or psychological statement
  • Assessment by school or therapist
  • Justification of the necessity

Income & cost sharing

Parents generally do not contribute to the costs of services in accordance with Section 35a SGB VIII.


Submit an application

  1. Contact the youth welfare office
  2. Counseling interview
  3. Submit the documents
  4. Examination & written decision

💡 Tip: Ask specifically for specialist centers for participation or mental health.

 

3. care insurance: check care aids


If you have a care degree, care aids can be covered, e.g:

  • Care beds, positioning aids, incontinence material
  • Everyday aids such as shower stools or mobile ramps

💡 Tip: An informal application with the reason "to make care easier" is often sufficient.

 

4. foundations: targeted support for families

  • Aktion Mensch
  • German Relief Organization Foundation
  • Herzenssache e. V.
  • BILD hilft e. V. "A heart for children"
  • Small patients in need e. V.
  • Regional foundations

💡 Tip: Use portals such as stiftungen.org or Foerderdatenbank.de.

 

5 Employers, associations & local campaigns

  • Hardship funds from employers
  • Fundraising campaigns by associations
  • Crowdfunding (e.g. Betterplace, GoFundMe)

6. tax relief

  • Extraordinary burdens
  • Lump sum for the disabled

💡 Tip: Use tax advice or income tax assistance.


7. advice & support

  • EUTB - nationwide & free of charge
  • Social associations such as VdK or SoVD
  • Family counseling centers & self-help groups

8. conclusion


If the cash register says "no", that's not the end. 💚
There are many ways to finance an aid anyway - sometimes with the support of public authorities, sometimes through foundations or your social environment.The important thing is to keep at it and get support - because you don't have to go this route alone.

Tips from the community

 

We are currently looking for alternative funding options as our immediate orthosis has been rejected. Unfortunately, the Auschschuss cannot approve any either.

We have private health insurance and unfortunately have to cover a lot of the costs ourselves, which is not so easy as a privately insured person.

At the time, an association of which we are a member temporarily subsidized the costs of a GPS orthosis on the condition that we would call in a lawyer and demand that the costs be covered. A few years later, the health insurance company covered the costs after the expert officially approved the GPS orthosis.