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Health insurance does not have to cover health tourism costs in Turkey
A man from Lower Saxony, who was treated for Lyme disease in Turkey, has to bear the costs himself. According to a current court ruling, the disease is also easy to treat in Germany. Therefore, the health insurance does not have to pay for treatment abroad.
Get diseases treated abroad
Although health care in Germany is the best in Europe according to a study, it can be worthwhile in certain cases to seek treatment abroad. So it can sometimes make sense to have certain dental treatments carried out outside Germany if the grants are granted by the German health insurance companies. This helps you save. However, having diseases treated in other countries that can also be treated in this country is not an advantage. This is also shown by a current court decision.
Health insurance company refused to reimburse the costs
The State Social Court of Lower Saxony-Bremen (LSG) has ruled that Lyme disease is easy to treat in Germany. It is not necessary to travel to doctors in Turkey for this.
A 40-year-old, Turkish-born man from the district of Vechta (Lower Saxony) had sued and was bitten by a tick many years ago. Shortly before Christmas 2014, he traveled to Turkey to have the painful Lyme disease symptoms treated.
After his return in January, he presented numerous invoices (the equivalent of approx. € 860) to his health insurance company, the AOK - the health insurance for Lower Saxony.
The latter declined to pay because the treatment would also have been possible domestically and there had been no emergency.
Furthermore, the plaintiff did not apply for prior approval from the health insurance fund for treatment abroad.
Lyme disease treatable in Germany
The plaintiff argued that the doctors in Germany had no more advice about his pain and had recommended psychiatric treatment. Only after treatment in Turkey did he become reasonably painless.
The costs incurred are relatively low and he finally claims no further expenses, such as Travel and flight costs.
The LSG did not follow that. In principle, reimbursement of costs is only possible for treatments that are not affordable in Germany or for emergencies. However, Lyme disease can be treated well in Germany.
The plaintiff was by no means unsuccessfully treated in Germany, since until now he had only visited doctors in his immediate area of residence and had not consulted any specialists.
There is no medical emergency when treatment is planned
"The plaintiff also did not come close to explaining which specific therapy, which was supposedly not supposed to be possible in Germany, was supposedly successfully treated in Turkey," the judgment says.
Merely the subjective success of an unspecified treatment cannot trigger a claim for reimbursement. Furthermore, there was no medical emergency for a planned treatment.
The court did not consider the previous application to the health insurance company - as the plaintiff claims - to be unnecessary formwork, but rather as a necessary prerequisite for the granting of benefits.
Because a previous application would have made it possible, in particular, to provide advice on further specialist treatment in Germany. (ad)