Kostenerstattungspraxis obsolet?

Ist die Kostenerstattungsprasis inzwischen obsolet? Nicht ganz, sollte man meinen. Es wird immer wieder davon berichtet, dass Patienten trotz Empfehlung zur Psychotherapie über die Terminservicestelle (TSS) der Kassenärztlichen Vereinigung nicht an einen Kassentherapeuten vermittelt werden können.

Die Gründe hierfür liegt zum einen darin, dass es zu wenige Kassensitze gibt und dass Kassentherapeuten freiwerdende Plätze nicht konsequent genug an die TSS melden. Wie auch immer, jedenfalls gibt es immer wieder Versuche, über Privatpraxen im Kostenerstattungsverfahren eine Kostenübernahme zu erwirken. Die Hürden für den Erfolg auf diesem Weg liegen einerseits bei der jeweiligen Krankenkasse (KK) und zum anderen beim begutachtenden MDK.

Es wird immer wieder von Fällen berichtet, bei denen sowohl der MDK über viele Anträge und Widersprüche gegen Ablehnungen keine medizinische Notwendigkeit für eine Behandlung sehen kann. Bis das dann nach sehr langer Zeit doch irgendwann die Behandlungsnotwenidgkeit in Verbindung mit der Empfehlung zur Kostenerstatttung eingeräumt wird.

Eine andere Variante, die jetzt offenbar häufiger wird, ist die Verschleppungstaktik durch die jeweilige Krankenkasse selbst. So kommt es vor, dass die KK ohne MDK-Prüfung ablehnt und die Unterlagen zurückgeschickt, nach Widerspruch wird wieder abgelehnt ohne dass die Unterlagen zurückzuschicken, nach erneutem Widerspruch – diesmal ohne die Antragsunterlagen erneut mitzuschicken, weil sie ja nicht zurückgeschickt worden waren – wieder Ablehnung mit der Begründung es lägen keine Antragsunterlagen vor. U.s.w. u.s.w. Diese Spielchen können sich über Monate hinziehen.

Wenn diese Hürde dann irgendwann genommen wurde, beginnt das Spiel mit dem MDK, was ebenfalls wiederum viele Monate in Anspruch nehmen kann. Es ist zu fragen, ob unter diesen Voraussetzungen noch sinnvoll unter Einhaltung der Abstinenzregeln psychotherapeutisch gearbeitet werden kann? Ich persönlich würde das infrage stellen wollen, gestehe aber zu, dass diese Problematik von jedem Psychotherapeuten anders beurteilt werden kann. M.E. ist für Patienten nur ein Antragsverfahren zumutbar, dass nicht willkürlich sondern transparent unter Beachtung nachvollziehbaren Regeln im zeitlich überschaubaren Zeitfenster abläuft. Solange dies nicht gewährleistet ist, werde ich das Kostenerstattungsverfahren in meiner Praxis nicht anbieten.

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We implement a variety of security measures to maintain the safety of your personal information when you place an order or enter, submit, or access your personal information. We offer the use of a secure server. All supplied sensitive/credit information is transmitted via Secure Socket Layer (SSL) technology and then encrypted into our Payment gateway providers database only to be accessible by those authorized with special access rights to such systems, and are required to?keep the information confidential. After a transaction, your private information (credit cards, social security numbers, financials, etc.) will not be kept on file for more than 60 days.

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We do not sell, trade, or otherwise transfer to outside parties your personally identifiable information. This does not include trusted third parties who assist us in operating our website, conducting our business, or servicing you, so long as those parties agree to keep this information confidential. We may also release your information when we believe release is appropriate to comply with the law, enforce our site policies, or protect ours or others rights, property, or safety. However, non-personally identifiable visitor information may be provided to other parties for marketing, advertising, or other uses.


The minimum information we need to register you is your name, email address and a password. We will ask you more questions for different services, including sales promotions. Unless we say otherwise, you have to answer all the registration questions. We may also ask some other, voluntary questions during registration for certain services (for example, professional networks) so we can gain a clearer understanding of who you are. This also allows us to personalise services for you. To assist us in our marketing, in addition to the data that you provide to us if you register, we may also obtain data from trusted third parties to help us understand what you might be interested in. This ‘profiling’ information is produced from a variety of sources, including publicly available data (such as the electoral roll) or from sources such as surveys and polls where you have given your permission for your data to be shared. You can choose not to have such data shared with the Guardian from these sources by logging into your account and changing the settings in the privacy section. After you have registered, and with your permission, we may send you emails we think may interest you. Newsletters may be personalised based on what you have been reading on theguardian.com. At any time you can decide not to receive these emails and will be able to ‘unsubscribe’. Logging in using social networking credentials If you log-in to our sites using a Facebook log-in, you are granting permission to Facebook to share your user details with us. This will include your name, email address, date of birth and location which will then be used to form a Guardian identity. You can also use your picture from Facebook as part of your profile. This will also allow us and Facebook to share your, networks, user ID and any other information you choose to share according to your Facebook account settings. If you remove the Guardian app from your Facebook settings, we will no longer have access to this information. If you log-in to our sites using a Google log-in, you grant permission to Google to share your user details with us. This will include your name, email address, date of birth, sex and location which we will then use to form a Guardian identity. You may use your picture from Google as part of your profile. This also allows us to share your networks, user ID and any other information you choose to share according to your Google account settings. If you remove the Guardian from your Google settings, we will no longer have access to this information. If you log-in to our sites using a twitter log-in, we receive your avatar (the small picture that appears next to your tweets) and twitter username.

Children’s Online Privacy Protection Act Compliance

We are in compliance with the requirements of COPPA (Childrens Online Privacy Protection Act), we do not collect any information from anyone under 13 years of age. Our website, products and services are all directed to people who are at least 13 years old or older.

Updating your personal information

We offer a ‘My details’ page (also known as Dashboard), where you can update your personal information at any time, and change your marketing preferences. You can get to this page from most pages on the site – simply click on the ‘My details’ link at the top of the screen when you are signed in.

Online Privacy Policy Only

This online privacy policy applies only to information collected through our website and not to information collected offline.

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Changes to our Privacy Policy

If we decide to change our privacy policy, we will post those changes on this page.
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