What is the task of the medical service?
The MDK is the socio-medical advice and appraisal service of the statutory health and long-term care insurance. It ensures that the benefits of health and long-term care insurance benefit all insured persons under the same conditions according to objective medical criteria.
Why the medical service?
The “Medical Service of Health Insurance” works as an appraiser for health and long-term care insurance companies. He is consulted, for example, when assessing the need for care, when applying for rehabilitation, when making controversial (often expensive) decisions about forms of medical care or when there are doubts about the inability to work.
Who decides MDK or health insurance?
Ultimately, the decision lies with the health insurance company. Even if the medical assessment is carried out by the MDK, the decision on a service always lies with the health insurance company. The experts make recommendations, but do not intervene in the medical treatment.
Who hires medical services?
On July 1, 2008, the National Association of Statutory Health Insurance Funds (GKV-Spitzenverband) assumed responsibility for the medical service at federal level (Medical Service of the Central Association of Health Insurance Funds, MDS). He advises the National Association of Statutory Health Insurance Funds on medical issues and coordinates the tasks of the medical services.
When do you have to go to the medical service?
The health insurance companies are legally obliged to have the incapacity for work of insured persons assessed by the MDK when it comes to ensuring the success of the treatment and restoring the ability to work, or. if there are doubts about the inability to work.
Does every health insurance company have its own medical service?
The health insurance medical service is a joint facility of the statutory health and nursing care insurance funds and is organized as an independent working group in each federal state. In North Rhine-Westphalia there is the MDK North Rhine and the MDK Westphalia-Lippe. There are 15 MDK in total.
Who finances the medical service?
The MDK are joint institutions of the statutory health and long-term care insurance funds in the federal states. Half of them are financed by the health insurance companies and half by the long-term care insurance companies.
Can employers commission medical services?
Can the employer send employees to the medical service? Employers cannot ask employees to contact the medical service of the health insurance company for an examination and to submit a statement on the result of the examination.
What is an MDK exam?
The MDK is currently reviewing the nursing and medically prescribed nursing services and the organization there. In addition, a survey of those in need of care takes place. The MDK has also been checking the accounts of outpatient care services since 2016.
How long does an MDK exam take?
How long does an MDK exam take? As a rule, an MDK exam lasts one to two days.
What does the MDK do during an assessment?
Do you have to drive to the practice or does the doctor make house calls? Do you take the medication yourself or do you need help? Are you cared for by relatives or by a nursing service?
What does the MDK check at the care level?
The MDK appraiser uses 6 modules to examine the individual areas of life of the person in need of care. To do this, he works with a questionnaire. If you would like to know what questions the MDK assessor asks, you can use my free care level calculator.
What documents does the MDK need?
Have copies of the following documents ready for the assessment appointment: current reports from doctors and specialists current discharge reports from the hospital or rehabilitation facility medication plan severely disabled ID card (if available)
Who decides the level of care?
MDK decides on care level assignment If insured persons apply for care services for the first time, the need for care is determined by the medical service of the health insurance company (MDK) on behalf of the care insurance companies.
Who determines the level of care?
If you or one of your relatives are in need of care, you must submit an application to your responsible long-term care insurance fund for a degree of care to be granted. After checking the formal eligibility, your long-term care insurance company will pass on the assessment of your case to the medical service of the health insurance company (MDK).
How is the level of care determined?
As soon as the application has been submitted to the long-term care insurance fund, the latter commissions the medical service of the health insurance company ( MDK ) or an independent expert to assess the need for long-term care.
How is a degree of care determined?
Normally it works like this: After applying for a degree of care, the care insurance company commissions the medical service of the health insurance companies (MDK) to determine the need for care. For those with private long-term care insurance, this is usually done by the Medicproof appraisal service.
Is the degree of care checked?
According to § 33 SGB XI, the decision on a degree of care or other services can also be limited if, for example, an improvement is to be expected. Before the deadline expires, the long-term care insurance fund then carries out a new assessment to determine whether the degree of care is still appropriate or not.
What level of care for mental illness?
We have left care levels 4 and 5 unmentioned because people with depression and without other physical or psychological limitations are entitled to benefits from the care insurance fund according to the NBA and the families also urgently need them.
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