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Statutory health insurance companies do not pay for rhythmic massages
The statutory health insurance companies are not automatically obliged to bear the costs of alternative treatment methods, even if the remedies of anthroposophic medicine are recognized by the legislature as a "special therapy". This emerges from a judgment of the State Social Court (LSG) Hessen in Darmstadt, in which the judges had rejected the costs for the treatment with so-called "rhythmic massages by the plaintiff's statutory health insurance".
In the justification of the judgment, the judges of the LSG explain that the basis for reimbursement of treatment by the statutory health insurance (GKV) is a positive assessment of the Federal Joint Committee (G-BA). As this is not yet available for the anthroposophical treatment method of rhythmic massages, the health insurance companies are not obliged to pay the costs. (AZ: L 8 KR 93/10)
No right to assumption of costs for alternative therapies The legislator has clearly stipulated in §2 of the fifth Social Code (SGB V) that "treatment methods, medicinal and therapeutic agents of the special therapy directions" are not excluded from the assumption of costs by the SHI. However, in individual cases no right to reimbursement of costs can be derived from this if the G-BA has not yet received a positive assessment of the treatment method used, according to the judgment of the Hessian State Social Court. In the corresponding proceedings, a 77-year-old woman from Marburg sued her health insurance company because she refused to pay the bills submitted for the patient's rhythmic massages. The doctor treating her had prescribed the massages for the treatment of her rheumatism, hoping to alleviate his patient's complaints based on the alternative treatment method from the field of anthroposophic medicine.
Alternative treatment method of rhythmic massage The rhythmic massages were developed by the anthroposophical doctor Ita Wegman, who - for the first time in the Ita Wegman Clinic in Switzerland, founded in 1921 - used it for the comprehensive treatment of patients. By combining classic massage methods with the approaches of the anthroposophy developed by Rudolf Steiner, the area of application of rhythmic massages has been significantly expanded compared to conventional massages. For example, Ita Wegmann also used her massage method to treat functional disorders of the organs. The aim of rhythmic massage is primarily to improve the blood circulation and tissue fluid movement in the organism, as well as to eliminate incorrect tension in muscle and connective tissue. This should improve breathing and cardiovascular function, for example. According to the users, the rhythmic massages also contribute to the normalization of digestion and the strengthening of the self-healing powers.
Health insurance company refuses to cover costs for rhythmic massage Despite these well-known health-promoting properties of rhythmic massages and the consideration of alternative treatment methods by the legislature, it is not yet mandatory for statutory health insurance funds to cover costs. The plaintiff's health insurance also refused to reimburse the alternative treatment method, on the grounds that it was to be rated as a "new treatment method", since the G-BA had not yet classified it. The fact that rhythmic massages have been used in anthroposophic medicine for decades did not matter to the health insurance company of the 77-year-old patient. The lady saw her rights violated in such a way that she went to the Hessian State Social Court. However, the judges followed the opinion of the health insurance and decided in their judgment published on Thursday (February 2nd) that the prerequisite for reimbursement of costs by the insurance company was a positive assessment of the treatment method by the Federal Joint Committee. The LSG judges refused to bear the costs for the rhythmic massage from the health insurance company, as the G-BA has not yet given a positive classification of the treatment method.
Assessment of rhythmic massage required by the G-BA During the course of the proceedings, the plaintiffs' lawyers also attempted to claim a system failure that, in case of doubt, would have required the health insurance to pay benefits. In the judge's opinion, however, this was not the case, since in addition to the rhythmic massages, numerous other treatment methods such as classic massages or physiotherapy were available for the therapy of the applicant's rheumatism. A system failure could not be recognized here, the judges judged. Nevertheless, it remains to be criticized that the G-BA has not yet carried out an assessment of the rhythmic massages and therefore there is no legal certainty when it comes to assuming the costs. In the interest of patients who would like to use this alternative treatment method, a timely classification of rhythmic massages would be extremely desirable. (fp)
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