Ombudsman Achitz: States and health insurance companies should first provide services and then work out in the background who will cover which costs
Vienna (OTS) – 19-year-old Marko J. has a rare neurological disease that causes him to lose many abilities in fits and starts. He was in the hospital for a long time because of a corona infection and was scheduled to be released into intensive care at home in autumn 2022. He has to be ventilated and fed through a tube. To prevent him from suffocating, he must be monitored and cared for around the clock by qualified nurses. “It is a clear case that the health insurance company is responsible for this; there are Supreme Court rulings on this. But the ÖGK is once again avoiding its obligations,” criticizes Ombudsman Bernhard Achitz, who repeatedly brought the topic up on the ORF program “Citizens’ Advocate”, most recently on June 8th. He will also point out the massive need for action to members of the National Council.
After several months in the hospital, Marko J. should be released from the hospital in autumn 2022. The Favoriten Clinic prescribed all-day home intensive care. However, the ÖGK did not seem to want to deal with it any further and returned the ordinance without comment.
OGH has determined that intensive care for those requiring ventilation is medical treatment
Strictly speaking, the ÖGK should provide 24-hour intensive care as a benefit in kind, i.e. send suitable carers. However, since she does not have a contractual partner for this, there is a financial subsidy according to the statutes. “The hourly rate does not cover the costs for one hour of care by any means,” says Achitz: “Instead of paying out support for at least 24 hours, the ÖGK has now offered ten hours after the Ombudsman intervened. I don’t see that there is any haggling with the affected families like at a flea market, because the OGH has clearly decided that the intensive care of those requiring ventilation is to be viewed as medical treatment and that the health insurance company must therefore pay.”
Marko J. was able to be released from the hospital in February 2023 – but only because the Vienna Social Fund (FSW) promised to temporarily cover the entire costs for which the ÖGK is actually responsible. However, Marko J. and his father were asked to request an actionable notice from the ÖGK and to go to court.
The Ombudsman calls for the principle of “pay first, then divide the costs” for all cases in which health insurance companies and states disagree about who is responsible. The people affected and their families should not be subjected to endless official channels. Funds and states should first make the service available and then work out in the background how they will divide the costs among themselves,” said Ombudsman Achitz.
Questions & Contact:
Florian Kräftner
Media spokesman in the office of Ombudsman Mag. Bernhard Achitz
+43 664 301 60 96
florian.kraeftner@volksanwaltschaft.gv.at
volksanwaltschaft.at