Health insurance companies have to pay for an electronic "foot lifter system"

LSG Stuttgart sees clear benefits in use for two people with MS
The statutory health insurance companies have to pay insured persons with a nervous walking disorder an electronically controlled "foot lifter system". It depends solely on the benefits for the insured, as the Baden-Württemberg State Social Court (LSG) in Stuttgart decided in two judgments announced on Tuesday, June 26, 2018 (file number: L 4 KR 531/17 and L 11 KR 1996/17). A positive recommendation from the Federal Joint Committee (G-BA) is not necessary.

The LSG thus approved two women, each suffering from multiple sclerosis (MS) about 15 years ago. This is a chronic inflammation that attacks the protective layer of the nerve fibers. This often affects the nerve impulses on the muscles and thus weakens the muscles in the long run. The number of diseases in Germany is estimated at over 200,000.

Her doctors had ordered the two plaintiffs to use the "Ness L300" electronic foot lifter system. The device from the US manufacturer Bioness is attached to the calf with a cuff. Software analyzes the motion sequences and also the nature of the floor. From this it calculates electrical impulses that are sent wirelessly to the foot lifter muscle in the front shin. The costs in 2015 were 5,500 euros plus additional costs, for example for a briefing. According to the manufacturer, the device is also suitable for other nerve disorders, such as after a stroke or spinal cord injuries.

For the two women with MS, the health insurance companies refused to pay for the devices. They referred to conventional aids such as bandages and orthoses. There is still no positive recommendation from the G-BA for the electronic foot lift system "Ness L300". This body, which is made up of doctors and health insurers, decides which treatment methods the statutory health insurers pay for.

But here the device "does not serve the actual treatment of the sick, but has the aim of improving the ability to walk and mobility as an aid to immediate disability compensation," emphasized the LSG Stuttgart. A positive decision by the G-BA was not necessary for this. Insured persons should not have to refer to less expensive but less effective aids here. Rather, there is a "right to compensate for the functional deficit as far as possible, taking into account the current status of medical and technical progress".

With the judgment of June 15, 2018, the 4th and on June 19, 2018 the 11th Senate of the LSG Stuttgart were convinced that “the new foot lifter system brings decisive improvements for the walking ability and mobility of the insured and therefore the care is necessary and justified ”. Both Senates based themselves on video documentation, which had been commissioned by the health insurance company in the first case and the LSG in the second. mwo / fle

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