Ambulance transportation: When does the health insurance company pay?

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Health insurance does not always take care of the transport to the clinic

Accidents, a suddenly occurring serious illness or an old lady who is in a wheelchair and does not come to the doctor on her own: In an emergency, transportation to the doctor's office or clinic can quickly become necessary. However, the costs of patient transport are not always borne by the health insurers; instead, patients often have to pay for them themselves, at least in part.

Travel has to be medically necessary, whether by taxi, private ambulance or ambulance - if you have to be transported to the clinic or to a doctor, you cannot automatically assume that the costs will be borne by the statutory health insurance companies. Instead, they only pay in certain cases: "Basically, the journey must be related to medical care and be absolutely necessary," Ann Marini from the GKV head association in Berlin told the news agency "dpa". According to Ann Marini, paragraph 60 of the Social Security Code (SGB) V would regulate exactly which conditions would have to be met to cover the costs. According to the law, transport of the sick "for imperative medical reasons" is in any case taken over by the health insurers, which vehicle can be used for it, according to the medical need in individual cases.

Cash registers may also cover costs for trips to outpatient treatment. According to Ann Marini, the cash registers would not only cover transport in an emergency, but would also provide other services under certain conditions. This would include moving to another hospital, if this "is necessary for compelling medical reasons" or if, after consultation with the health fund, it seems sensible to move to a hospital close to home. In addition, according to the "§ 60 travel costs" in conjunction with § 115a or § 115b, the health insurers would also assume the costs for pre- and post-inpatient treatment or an outpatient operation - provided that these prevent or reduce full inpatient or semi-inpatient treatment in the hospital can.

Special regulations for severely disabled or patients in need of care Under certain conditions, the health insurers would also pay for trips to other outpatient treatments, but only after prior approval, the expert from the GKV head association further told dpa. According to Ann Marini, this would include dialysis treatments, but also oncological radiation and chemotherapy. In addition, there would be special regulations for severely disabled or in need of care, to whom, for example, the travel or travel expenses in connection with medical rehabilitation measures would be paid according to Section 53 (1) to (3) SGB IX.

Surcharges for trips to outpatient treatment Without "compelling medical reasons", transporting patients to outpatient treatment is not entirely free of charge, because affected persons have to pay five, at most ten, euros according to paragraph 61 ("surcharges") - regardless of which means of transport is used has been. Accordingly, it can be summarized: If there is no medical need, the statutory health insurance companies are not obliged under § 60 SGB V to assume the costs of an ambulance. Even if you get sick abroad or have an accident, you cannot automatically rely on the support of your health insurance fund, because, according to § 60 (4), the costs of return transport to Germany are not borne. (No)

Image: W. Broemme /

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