2024-09-22 06:15:17
The brothers Karl and Georg B. have the metabolic disease Hunter’s disease. Both therefore require the same treatment: enzyme replacement therapy, in which the drug Elaprase is administered via infusion. Karl B. is insured with the ÖGK. This enables him to have the weekly infusion administered at home by a nurse.
His brother Georg B. worked in the kitchen of a state nursing home, so he is insured with the BVAEB. They refuse to allow him to receive home therapy. His mother Marianne B. has to drive him 30 kilometers to the hospital each time and then back home after the five-hour treatment. “I’m at the end of my tether,” she said on the ORF program “Citizens’ Advocate.”
Ombudsman Bernhard Achitz: “While the ÖGK has obviously reached an agreement with the state of Lower Austria on the processing and cost allocation, the BVAEB has not managed to do so. This is a prime example of the absurdity of the fragmented social insurance system. The often promised standardization of benefits is apparently still a long way off.”
The BVAEB and the state blame each other for the non-approval. “Unfortunately, this often happens. The Ombudsman calls for the principle of ‘pay first, then split the costs’ in all cases in which health insurance companies and states disagree about who is responsible. The people affected and their families should not be harassed with endless bureaucratic procedures. Health insurance companies and states should first provide the service and then work out in the background how they will split the costs between themselves,” says Ombudsman Achitz.
SERVICE: The Ombudsman can be reached at post@volksanwaltschaft.gv.at or by calling the toll-free service number 0800 223 223.
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