How to read and assess decisions on children's aids correctly
The letter from the health insurance company arrives in your letterbox - and at first glance it's often not clear what it actually says. Approved? Partially approved? Rejected? Especially when it comes to children's aids, many parents feel overwhelmed by the wording, paragraphs and technical terms.
In this FiNiFuchs HowTo, we show you how to read a health insurance notification correctly, what you should look out for when making decisions about the provision of aids and how to assess whether the notification really suits your child's needs.
Why health insurance notifications are often so difficult to understand
Health insurance notifications are legal documents. They should be legally correct - not necessarily easy to understand. Terms such as "sufficient, appropriate and economical" or references to paragraphs in the German Social Code are standard, but say little about how well an aid actually supports your child's everyday life.
There is often an area of conflict here, especially with children's aids: the decision evaluates formal criteria, while parents focus on their child's everyday life, development and individual needs. This makes it all the more important to decipher the content of a decision step by step.
The first look: What was actually decided?
Before you get confused by long passages of text, it's worth starting with a structured approach. First look for the actual decision section. It is often hidden behind phrases such as "We decide as follows" or "The application is ... granted".
This shows whether the requested aid has been approved, only partially approved or rejected. It is not only the "yes" or "no" that is important here, but also what exactly has been approved. With children's aids in particular, it can happen that a different model, reduced equipment or a time limit is approved.
What does "sufficient, appropriate and economical" mean?
This phrase appears in almost every health insurance notification - and regularly causes uncertainty. It does not automatically mean that the aid is ideal for your child. The health insurance company checks whether, in its opinion, a fitting meets the minimum legal requirements.
For parents, this means that even if a decision is formally correct, it may not be relevant to everyday life. The decisive factor is whether the approved aid actually enables the participation, development and care of your child. This is exactly where it is worth taking a closer look.
Important points in the health insurance notification
Pay particular attention to these points when reading the notification:
- What decision was made (approval, partial approval, rejection)?
- Which specific aid or design is mentioned?
- Is there a time limit or conditions?
- What reasons does the health insurance company give?
- Is an appeal period specified?
These points will help you to understand the decision without having to understand every word immediately.
Read justification: What does it say - and what doesn't it say?
The reasoning in the health insurance company's decision often sounds very clear, but is often general. Statements such as "not medically necessary" or "not required" usually refer to the health insurance company's assessment - not automatically to your child's actual situation.
With children's aids in particular, it is worth comparing the justification with medical reports, therapy recommendations and your everyday experiences. If these have not been taken into account or important aspects are missing, this may indicate that the decision is not fully based on your child's needs.
These terms come up frequently
Many parents stumble across similar phrases. You will come across these terms particularly often:
- Medical necessity: The health insurance company does not see a compelling need
- Economic alternative: Reference is made to a cheaper aid
- not in the list of medical aids: The medical aid is not listed, but not automatically excluded
- Case-by-case assessment: The need was assessed individually - at least formally
These terms are not the end of the discussion, but often the starting point for queries or an objection.
Deadlines and rights: don't rush things now
An important part of every health insurance notification is the information on legal remedies. It states how long you have to respond - usually one month from receipt of the notification. You should take this deadline seriously, even if you are still unsure.
You don't have to decide everything immediately. It is often enough to react within the deadline and consult with doctors, therapists or the medical supply store at the same time. Especially when it comes to children's aids, it makes sense not to make decisions based on a letter alone.
Conclusion: Health insurance decisions are not the end of the story
A decision from the health insurance company is not a final verdict on your child's needs. It is a formal decision that you can review, question and - if necessary - challenge. The better you understand what it says, the more confident you can be about what next steps make sense.
With calm, structure and a view of your child's everyday life, a letter that is difficult to understand will become a document that you can work with.
Tips from the community
I don't immediately read the notification "emotionally"
When the health insurance notification arrives, I sometimes put it aside for a while. With a little distance, I find it easier to read the content objectively and understand what was really decided.
I mark important passages
I cross out the decision, the reasons and the deadline in the notification. This helps me to keep an overview - especially when there are several letters about the provision of medical aids in circulation.
I get support
If I am unsure, I discuss the decision with our therapist or the medical supply store. A second look often helps to assess whether the decision really suits my child's needs.