Tricky issue with insurance claiming

17 posts in this topic

Posted

So I am in a tricky situation with an Insurance company. I am a postdoc in a Max Planck Institute in Germany. On the day of my arrival to Germany my wife fell from the train in the station and was taken to the hospital with a broken nose. I got my bills, I payed them and everything was ok.

As required by the MPI institute and the German government I had to take Health Insurance and I choose one that complies with the German public insurance laws (Offered by Halleschele)that by the way is quite expensive (+200 Eur pp but the MPI gives you a hand with payments). So here comes the source of my question: With the help of the people from the MPI applied for the insurance on October 7 and I didnt got my insurance card and papers until the second week of november, and to my surprise, the insurance charged me for October and November. So my question is this: Given that the insurance company charged me for the whole month of October can I submit the bills from my wife´s medical treatment for re reimbursement? even though the accident happened before I applied for the insurance? I have to stress that in the application forms for the insurance company made no questions about previous health conditions.

Thank you very much for your help.

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Posted

This is a bit unclear, xiuh. When was the starting date for the insurance? They charged you for October, ok. There were no health questions??? Something wrong there. You and your wife didn´t need to go to a doctor for a medical check up? Also sounds very strange.

 

You need to contact the insurance person who stamped and signed the application form (with the help of the MPI ).Only he or she can really help.

 

By the way, also ask whether you have a so-called deductible/excess (German word: Selbstbeteiligung) in the contract ie you might have to pay the first x amount of medical bills per year yourself anyway.

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Posted

Hello! Thank you for your answer. I think I will go tomorrow morning to the human resources office to get all this sorted out. Thank you for suggesting the new questions that I will also ask now to the people in that office :)

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Posted

Good luck and let us know what happens! This sounds really strange. Normally, newcomers to Germany have to have a medical check up for private health insurance. Hallesche is a private insurance - not public. It´s actually a company with a good reputation but I don´t know what´s behind this!

 

Possibly, your Institute has some kind of special arrangement as a group scheme without the need for a medical report. If so, that could work in your favour.

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Posted

..unrelated, xiuh, but also make sure you do some research into another essential insurance in this country: personal liability insurance. The German term is private Haftpflichtversicherung. Ask your Institute about this. Essential! You may not have heard of it.

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Posted

Me and my wife arrived some months ago, we got insured but did not require a medical check up. And why should we? What would a medical check up change?

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Posted

Mike: if you got public insurance, no check ups. NO exclusions for pre-existing conditions.If you got private insurance, then it depends on the private insurer. Doctor visit and maybe dental..maybe hospital records...depends. In private insurance they want to know how healthy you are or what a risk you are ie are you insurable?

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Posted

I don't quite understand why his wife would be covered under his policy if it's private...was surprised john_g didn't mention that. So what am I missing?

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Posted

I don't think she is - the OP said the insurance was "+200 Eur pp". So it sounds like they have separate policies.

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Posted

I hope you're right, El Jeffo. The way I read the first post, it sounds like he has one, and she doesn't.

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Posted

Hm, I read it like el Jeffo did but the post is a bit vague..I also hope el Jeffo is right!

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Posted

Regarding the question about she being included in my insurance I really dont understand the terminology but maybe this will make it clearer for the experts: When I got here and selected the insurance I wanted they gave me an application form where I wrote my wife´s and my own information. It was the same paper. The insurance policy arrived in the same folder and the Versicherungsbestätigung has both names and only one Versicherungsnummer. The price is calculated for each one of us and then added (she is a little bit cheaper than me)

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Posted

so it would appear that the MPI has set up a group tariff for ist employees/scientists...this then indeed does not require medical questions like an individual policy and more often than not, existing conditions are included. As seems to be the case here. Which means - if you are lucky, then Hallesche will pay for the treatment of your wife's unfortunate accident.

Worth a try for sure.

 

Cheerio

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Posted

By now I guess you already figured this out, but since you are a non-EU I think you technically have to buy insurance before arriving to Germany, but that's not what happened. I would assume your insurance covers you from the start of your working contract. When was the first day of work? And I am not sure if for insurance terms they will take calendar month.

 

If the bills are worth (check your deductible) you can just send them to your insurance, worst case they say no.

 

P.S., Bienvenido a Alemania buey.

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Posted

For Starshollow and Krieg: he took care of all that.

 

 

to be awarded the german visa to arrive here we had to buy one month of travel insurance so we will be submitting our bills to that company.

 

 

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Posted

To the original poster, I would keep the info in this post: http://www.toytownge...ic=211919&st=30 handy if you have any issues getting reimbursed. I was really glad to find it the other day.

 

Someone I know has been having issues with the same private insurance company you have and their dentist for over a year regarding reimbursement on something that was preapproved - but required a modification while it was being done.

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