Pati­ent trans­por­ta­tion pre­scrip­tion: when health insu­rance com­pa­nies cover your tra­vel costs

Patient transportation can be prescribed by a doctor, which means that statutory health insurance companies cover the travel costs. When does this apply to you?

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2 men are behind a vehicle with the doors open. One of the men is in a wheel­chair and is being pushed by the other man. 

Medi­cal pre­scrip­tion — new regulations

Since Octo­ber 1, 2020, there have been new regu­la­ti­ons for pati­ent trans­por­ta­tion. Trans­por­ta­tion can be pre­scri­bed if the jour­ney is medi­cally neces­sary.
But what con­di­ti­ons must be met for a jour­ney to be con­side­red medi­cally necessary?

  • The doc­tor deter­mi­nes that it is not pos­si­ble to tra­vel inde­pendently, e.g. by car or bus
  • A medi­cal mea­sure takes place at the place of treatment
    (mas­sa­ges, preli­mi­nary exami­na­ti­ons or picking up pre­scrip­ti­ons do not count)
  • The jour­ney must take a direct route from the patient’s place of resi­dence (e.g. home, acci­dent site, care faci­lity) to the appro­priate tre­at­ment facility

Howe­ver, it is legally not inten­ded for health insu­rance com­pa­nies to cover the tra­vel costs. In the fol­lo­wing, it is important to deter­mine whe­ther inpa­ti­ent or out­pa­ti­ent tre­at­ment is to be provided.

Dif­fe­ren­ces in the pre­scrip­tion of pati­ent transportation
Inpa­ti­ent tre­at­ment vs. out­pa­ti­ent treatment

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Left pic­ture: A woman lies in a hos­pi­tal bed and is ser­ved food by a nurse.
Right pic­ture: A woman is on her way out of the room. A doc­tor stands in the door­way and lets the woman walk past him. 

Inpa­ti­ent treatment

exists if pati­ents spend at least one day and one night at the place of treatment

  • Orde­ring of pati­ent trans­por­ta­tion by doc­tors if medi­cally neces­sary (health insu­rance com­pa­nies cover the costs)
  • Appr­oval from the health insu­rance fund is not requi­red (no appr­oval required)

Out­pa­ti­ent treatment

exists if pati­ents are allo­wed to leave the place of tre­at­ment imme­dia­tely after treatment

  • No pre­scrip­tion of pati­ent trans­por­ta­tion by doc­tors pos­si­ble (health insu­rance com­pa­nies gene­rally do not cover any costs)
  • Regu­la­ti­ons pos­si­ble in excep­tio­nal cases

Out­pa­ti­ent tre­at­ment: excep­tio­nal cases requi­ring authorization

Appr­oval requi­re­ment = pre­scrip­tion for the trip must be sub­mit­ted to the health insu­rance com­pany in advance

  • Pati­ents who require high-fre­quency tre­at­ment over a lon­ger period of time (dia­ly­sis tre­at­ment, radio­the­rapy or chemotherapy)</li
  • Pati­ents who require trans­por­ta­tion due to their state of health (e.g. infec­tious disease)

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Close-up of a desk: A per­son (left) hands a docu­ment to ano­ther per­son (right).

Out­pa­ti­ent tre­at­ment: excep­tio­nal cases wit­hout the need for authorization

wit­hout appr­oval requi­re­ment = pre­scrip­tion for the trip does not have to be sub­mit­ted to the health insu­rance com­pany in advance

  • Pati­ents under­go­ing out­pa­ti­ent sur­gery (inpa­ti­ent stay is avoided/shortened as a result)</li
  • Pati­ents who are rest­ric­ted in their mobility 
    • Care level 3 (if the pati­ent also has limi­ted mobility)
    • Care level 4, care level 5
    • Peo­ple with severe disa­bi­li­ties (mark “aG”, “BI” or “H

What means of trans­por­ta­tion are available?

A distinc­tion can be made bet­ween 3 dif­fe­rent means of transportation:
Pati­ent trans­port vehic­les, clas­sic ambu­lan­ces or emer­gency ambu­lan­ces and vehic­les for pati­ent trans­por­ta­tion. These include public trans­por­ta­tion or ren­tal cars and cabs that are equip­ped for the dis­ab­led (e.g. wheel­chair cabs).

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A man pushes ano­ther man, who is in a wheel­chair, into a wheel­chair cab. 

Spe­ci­ally equip­ped vehic­les, such as the wheel­chair taxi, are used to carry out pati­ent jour­neys. Trips with pri­vate motor vehic­les, ren­tal cars or public trans­por­ta­tion are also coun­ted as pati­ent jour­neys. Com­pared to pati­ent trans­por­ta­tion with pati­ent trans­port vehic­les, no medi­cal care is pro­vi­ded during the journey.

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Pic­ture of an ambulance 

Pati­ent trans­port vehic­les are used for trans­port­ing pati­ents. This means of trans­port is sui­ta­ble if pati­ents require spe­cia­list medi­cal care or spe­cial equip­ment in the vehicle during the journey.

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Pic­ture of an emer­gency ambulance 

A clas­sic emer­gency doc­tor or ambu­lance is used to carry out res­cue jour­neys. This also includes res­cue heli­c­op­ters. If pati­ents require spe­cial equip­ment or are in a cri­ti­cal medi­cal con­di­tion, this means of trans­port is suitable.

Am I entit­led to all means of transportation?

When it comes to choo­sing the most sui­ta­ble means of trans­por­ta­tion, it no lon­ger mat­ters whe­ther the pati­ent is an inpa­ti­ent or outpatient.
Howe­ver, the choice of means of trans­port depends on the fol­lo­wing points:

  • indi­vi­dual needs of the pati­ent (is medi­cal care pos­si­bly required?)
  • Ana­ly­sis of doc­tors for the most sui­ta­ble means of transportation
  • Health insu­rance com­pa­nies (can carry out an assessment)

Addi­tio­nal pay­ment for trans­por­ta­tion costs

If jour­neys are covered by health insu­rance, insu­red per­sons are unfort­u­na­tely still obli­ged to pay part of the costs of each jour­ney them­sel­ves. This also applies to child­ren and young people.
What you need to know about payment:

  • Pay 10% of the tra­vel costs per jour­ney (mini­mum five euros and maxi­mum ten euros per journey)
  • Dri­vers receive the money imme­dia­tely after transportation
  • If the bur­den limit accor­ding to § 62 SGB is excee­ded, insu­red per­sons can exempt them­sel­ves from the payments 
    • 2% of the gross income
    • 1% of gross income for the chro­ni­cally ill (if the ill­ness requi­res long-term treatment)

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6 dice with various sym­bols from the health sec­tor are arran­ged in a pyra­mid. The top die is tur­ned by a per­son and is the only die to show 2 sym­bols (hos­pi­tal cross and money coins). 

We hope we have been able to pro­vide you with a lot of inte­res­t­ing and important infor­ma­tion about pre­scrip­ti­ons for pati­ent transportation.
If you have any fur­ther ques­ti­ons, please cont­act a doc­tor or your health insu­rance company.

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