LSG Potsdam sees "system deficiency" if no doctor carries out treatment
Statutory health insurance companies have to cover the costs of medical foot care if they cannot name a doctor who actually performs medical treatment. This was decided by the Berlin-Brandenburg State Social Court (LSG) in Potsdam in a judgment published on Monday, November 6, 2017 (file number: L 9 KR 299/16). Specifically, it is a special treatment for ingrown toenails.
The plaintiff's nail on the left big toe grew chronically into the toe. This can be treated with a nail correction brace. This is attached under the nail edge so that the nail grows out normally. Until then, the brace must be checked and adjusted regularly.
This is actually medical treatment. However, the applicant was unable to find a doctor who carried out this treatment. Her health insurance company could not name a doctor for this either. The woman therefore opted for treatment with a medical podiatrist (podiatrist).
The health insurance company only contributed 100 euros to the costs of around 300 euros. This is not possible with the treatment. With the exception of the diabetic foot, medical foot care services are excluded from the statutory health insurance benefits catalog.
The LSG Potsdam agreed in principle, but nevertheless agreed with the patient. Because if it is a matter of medical treatment, there must also be doctors who carry it out. The health insurance company was also unable to name a doctor for this.
The Potsdam judges rated this as "a system deficiency". This allows "exceptionally the use of a non-medical service provider", here the podiatrist.
There is no doubt about their qualification. Because the job title podiatrist should only lead those who have completed a precisely prescribed training and a state examination. The nail braces treatment performed here is also part of the training program.
Against this judgment, which has now been published in writing on October 11, 2017, the LSG approved the appeal to the Federal Social Court (BSG) in Kassel due to its fundamental importance. mwo