Legal consequences for statutory health insurance companies: Two insurance companies forced to cease and desist

Legal consequences for statutory health insurance companies: Two insurance companies forced to cease and desist

According to a report from www.fr.de, two statutory health insurance companies, IKK classic and Big Direkt, have received legal consequences for incorrect behavior when dealing with DiGA prescriptions. The digital health applications (DiGAs) have been approved for the German market as “prescription apps” since 2020. Insured people can get access to such an app either through their health insurance company or through a doctor's prescription. However, some health insurance companies have tried to hinder access to certain DiGAs by suggesting other apps. This is viewed as an interference with the freedom of therapy of the doctor and the companies concerned.

In the case of IKK classic, a lawsuit was filed by aidhere, a company for digital health applications. The court ruled in favor of aidhere and forced IKK classic to sign a cease-and-desist agreement that was punishable by penalty. This means that the health insurance company will have to pay a penalty if it continues to try to redirect its policyholders to other apps.

The case against Big Direct was resolved out of court and the fund agreed to sign a cease and desist. Despite these legal implications, concerns remain as some health insurance companies are turning to new methods to hinder the prescription of DiGAs. For example, letters are sent to insured persons and medical staff to request further information before a DiGA is activated. This leads to uncertainty and possible rejection from patients.

The impact of these incidents on the market and the financial industry could bring more attention to compliance with patient rights and doctor's freedom of treatment. Digital health application companies could strengthen their position and ensure fairer treatment through legal action against health insurance companies. However, it is still unclear whether these violations of the law are systematic or due to ignorance of the new law. It should also be noted that many health insurance companies are organized in a decentralized manner, which can lead to delays in implementing new procedures. Nevertheless, the interference of regulatory authorities and courts shows that the enforcement of patients' rights is taken seriously and irregularities will not be tolerated.

Source: According to a report from www.fr.de, As reported by www.fr.de.