Obligation of private health insurers to provide advice

The private health insurance has a legal obligation to provide advice if there is a recognisable reason – and even more so if there is an explicit request – § 6 VVG. This also includes “human care until the end of life”, for example through palliative and, if necessary, hospice treatment, as well as through living wills – i.e. also “self-determined dying”.


Individual private health insurers already offer exemplary advice – 63% of the population is against the ban on active euthanasia. Non-Germans abroad can also give advice on this. The insurance cover in private health insurance extends to Europe: here there are several countries that allow active euthanasia and oblige hospitals to offer it, even for the mentally ill, and here even in Catholic hospitals of the “Merciful Brothers”.

Domestically, brokers and insurers are called upon to advise on a change of tariff – because according to the usual private health insurance tariffs, “purely life-supporting measures, without medical indication” are not even insured. The situation is similar for e.g. outpatient psychotherapy and essential aids, which are not covered by many private health insurance conditions – with a good chance of the unnecessary earlier death of the private health insurance policy holder. This is often different in the SHI system. The private health insurance is accused of wasting billions on homeopathy instead, without any proven benefit?


PKV association supports premature death or prolongation of suffering due to gaps in coverage?

The BGH (ruling of 19 May 2004, ref. IV ZR 176/03) decided among others “The purpose of such an insurance is not already decisively questioned if the policyholder, according to the underlying tariff, has to bear the costs of an aid prescribed for him/her in the context of a medical diagnosis, which is intended to compensate for the lost bodily function in daily use. This also applies in principle if this measure accompanying the medical treatment is to be regarded as necessary in order to prevent the possibility of otherwise arising, even serious, health risks”.


A breathing monitor for infants against sudden infant death is not even an aid, but as in clinical thermometers only a measuring device, which is not reimbursed by the PKV. Anyone who becomes incapable of working in the daily sickness benefit insurance scheme during the course of his or her incapacity to work will soon find himself or herself without income from private health insurance. And those who are only in hospital for care or custody are no longer reimbursed by the private health insurance – before the introduction of compulsory long-term care insurance they received nothing at all and then a partial coverage benefit, which had often been reduced by the last “care reform”.


The private health insurance wants to be there for its policyholders until the end of their lives – but not for every desired treatment that is no longer medically indicated due to the lack of a cure or even a prospect of improvement or alleviation, but if necessary only palliatively, and if possible also for permitted euthanasia, if he wants it, preferably even if he travels to Switzerland or Belgium for it. To refuse him this means that the PKV will abandon him at the end of his life. To shirk these questions as a private health insurance association with inappropriate disqualifying evaluations is deeply reprehensible. However, some private health insurers with an international and therefore more far-sighted background have recognised this and are doing something along these lines.


Necessary provision by PKV-insured persons and intermediaries towards PKV insurers?

Anyone who writes a corresponding patient will (advance directive) should clarify with his or her private health insurance company that it will not stab him or her in the back by paying doctors and hospitals for the unwanted measures to prolong suffering. He should have this confirmed. Perhaps with a sample letter, informing you of the order, or as an instruction? Comments by the private health insurance association give rise to fears of the worst, namely that it will continue to pay without restriction until the end of your life – so you have to take timely precautions with your private health insurance. For new insurance policies, this should be clarified and confirmed when the application is submitted. In the case of already existing private health insurance, make a declaration of intent and have it confirmed that the private health insurance will adhere to it. If necessary, terminate and change without notice – alternatively, one can also sue for a declaratory judgment that the private health insurance company is prohibited from paying for life-prolonging and suffering-prolonging measures contrary to the Patient Decree?

Many have an insurance card or clinic card that allows the hospital to bill the patient directly. These should be destroyed immediately so that they do not fall into unauthorized hands. Leaving the Clinic-Card to the hospital for direct settlement with the private health insurance can already lead to a serious self-denunciation. In this way it is possible to defuse the threat associated with the PKV association statement to a certain extent that the PKV could disregard the will of the (possibly unconscious) patient and thereby cause him or her unnecessary prolonged suffering. Mistrust is appropriate that the private health insurance undermines the Patient Decree to the detriment of the UN – timely prevention is necessary for the private health insurance to commit itself to compliance with the will of the patient. A less recommendable alternative would be, for example, a switch to statutory health insurance.


Numerous private health insurers earn several times over from the unnecessary hospital treatment that prolongs suffering:

– The benefits paid must be included in the premiums, thus increasing the premium income, including the administrative and claims settlement costs, and the profit via margins. The elderly people, who are mainly affected, have hardly any possibility to avoid the increases. It is proven that a large part of the expensive benefits are paid in the months before death.


– Each additional service provision increases the premium income through legally prescribed premium adjustment mechanisms.


– Every month that the insured are kept alive secures more of their premium income, including costs and profits. The possibly high benefits have already been taken into account, largely by withdrawing them from the ageing reserves. If this is not enough, the premiums may be increased by trustee approval. Whether these may even be legally ineffective because they are caused by treatments that are not covered by insurance is not regularly checked.


– For the benefits that increase with age, additional ageing reserves must be formed, from whose investment income the insurers earn additional income.


– By processing the additional benefits (which are included in the premiums), the personnel capacity can be better utilised – and at favourable marginal costs, since the overhead is already financed. This also increases the profit.


The sector does not keep its own hospital chain as a capital investment. The industry is also earning from the increased number of hospital cases due to life-prolonging and suffering treatments and the profits of these hospitals – the investment income of private health insurance is increased. This means that additional profits can be generated on the ageing provisions set up for these benefits.

The development of premium income and headcount to policyholders as well as profits are the yardsticks by which the remuneration and bonus payments of board members and often also senior executives are measured. Increased departures through compliance with the actual will of the insured at the end of their lives may mean that bonus payments are waived. As a result of the prolonged suffering of the insured at the end of their lives, management board members and employees benefit and their jobs are preserved. More premium income also benefits the lobbying association of the private health insurance association, where it allows for additional staff and promotions.

The additional employees involved in processing the unnecessarily extended benefit cases mean better promotion opportunities for some, for example as group leaders, and thus salary improvements.



Few PKV insurers respect the will of patients and protect their assets

The statement of a private health insurance association “Private health insurance advocates a very good and humane care of patients in every situation and especially at the end of life”. against this background is like a threat that makes one fear the worst. It is transparent, which is why the private health insurance industry evades discussion by using inappropriate language.


Private health insurance customers who want to shape the end of their lives themselves should contact their private health insurance company at an early stage and force it to make binding declarations that it respects the will of the patient and does not sabotage him or her by making payments past the patient. Doctors and hospitals disregard this out of greed and the private health insurance pays for this supposed “very good and humane care of patients in every situation and especially at the end of their lives” against the declared will of the insured, for equally selfish motives dressed up in moral phrases.


Even a power of attorney is of no use if the (provident) agent is ultimately unable to assert himself against the opposing coalition of doctors, hospitals and the private health insurance, also for financial reasons. He must take preventive action today and force the private sector to commit itself to recognition and subsequent action in accordance with his declared will. If necessary, he must force the KV to make a corresponding declaration in court if it refuses. Because this shows all the more how necessary it is to prevent the sabotage of the patient’s will by private health insurance.


Insured persons and patients must fear that, contrary to their declared will, they will be incapacitated at the end of their lives and in the case of serious illnesses by doctors and private health insurance companies who pretend that they mean well, but in reality profit in many ways from their suffering. Responsible pension fund officers – an alternative to the judicially appointed guardian – often need a “war chest” for support, possibly in addition to an RSV of the person concerned.


Some private health insurers themselves appear to be painless when it comes to unnecessary suffering of their policyholders at the end of their lives, suspiciously out of ruthless greed for money. Increasingly, however, other private health insurers are apparently beginning to adapt to the will of patients. Those who inform themselves will find suitable insurers here.


by Dr. Johannes Fiala and Dipl.-Math. Peter A. Schramm


by courtesy of

www.experten.de (published on 02.10.2018)


Link: https://www.experten.de/2018/10/02/verpflichtung-privater-krankenversicherer-zur-beratung/


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Dr. Johannes Fiala Dr. Johannes Fiala

Dr. Johannes Fiala has been working for more than 25 years as a lawyer and attorney with his own law firm in Munich. He is intensively involved in real estate, financial law, tax and insurance law. The numerous stages of his professional career enable him to provide his clients with comprehensive advice and to act as a lawyer in the event of disputes.
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