AOK Bayern terminates family doctor contracts without notice



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Dispute between family doctors and AOK Bayern

The AOK Bayern health insurance company terminates family doctor contracts without notice. The Bavarian Association of General Practitioners remains in its position and wants to force the health insurance companies to negotiate again about higher fees.

A new level of escalation in the dispute between the Bavarian medical profession and health insurance companies has been reached: The general local health insurance company AOK has terminated the general practitioner contracts without notice. The termination of contracts with general practitioners also has far-reaching consequences for AOK health insurers in Bavaria.

In the next week, Bavaria's general practitioner associations wanted to advise whether a majority of the general practitioners would give their health insurance license back at the beginning of 2011 in protest at the health care reform and thus exit the statutory health system. However, the AOK has come ahead of this announcement from the general practitioners. The health fund terminated the general practitioner contract with the Bavarian General Medical Association with immediate effect. The health insurance company justifies this drastic step with the fact that the association of general practitioners has announced that it will exit the system of statutory health insurance. In the view of the cash representatives, such a project violated German social law, as the AOK cash director of Bavaria, Helmut Platzer, emphasized. It was almost impossible and unreasonable for the AOK to work with an association that behaved unlawfully on key issues of social legislation. " After all, the health insurance company had already threatened to give notice at the beginning of December if the medical association did not waive its system exit plans. The termination of the contracts is without notice, but the AOK offers the medical association to take advantage of an expiry period by December 13, 2010 so that the current billing quarter can still be used and offset.

Far-reaching consequences for patients
The termination of family doctor contracts has far-reaching consequences for patients. AOK patients now have to do without additional services, for example, which are laid down in the contracts. This includes, for example, pension benefits such as the free health check that insured persons can carry out once a year. It becomes much more dramatic for patients suffering from chronic diseases. Here, special therapies for those affected are initially eliminated. In addition, the full practice fee is also payable for chronically ill patients. According to the contractual guidelines, those affected only had to pay the regular practical contribution of 10 euros once a year before termination. This cap on costs no longer applies to people insured with AOK.

Regular health care from the family doctor can still be used, as the AOK emphasized. The insured can of course continue to go to the family doctor and get treatment. The termination of the contract does not affect the approval of doctors' health insurances. The approval will remain in effect for the time being, unless the family doctors take it seriously and cancel the approval of the statutory health insurance company. "The patient's security of supply is fully guaranteed," said Platzer, chairman of the health insurance fund. The AOK will now fully inform AOK members about the current state of affairs and answer any questions. The escalation of the dispute affects around 2.6 million health insurers and around 7000 medical professionals in Bavaria.

Planned system exit with economic consequences for general practitioners
The AOK also informed the Bavarian Minister of Health Markus Söder (CSU) about the termination without notice. Here one was concerned and exhorted the general practitioners to exercise caution. Anyone who has exited the cash register system should stay outside, as Söder said in an interview. According to the Minister of Health, the planned return of the health insurance approval is a "one-way ticket".

AOK Bayern sees the outpatient care of the Bavarian population and the economic existence of thousands of medical practices threatened by the planned exit of the BHÄV system. "Because in the event of a collective system exit, all contracts with health insurance companies lose their validity by law." This has massive consequences for the doctors involved. They do not receive a fee from the Association of Statutory Health Insurance Physicians in Bavaria (KVB) or from health insurance companies. Patients can only be treated on a private bill, which the health insurances cannot reimburse. A new approval as a contract doctor is possible after six years at the earliest.

Bavarian Family Association remains in its position
The Bavarian Family Medical Association informs the insured in a circular to the insured. It reads like this: “There will soon be no more general practitioner contracts in their current form. This is ensured by an amendment to the law that drastically limits the scope for structuring family doctor contracts. Without general practitioner contracts, however, health insurance physicians can only work under the umbrella of the health insurance association. That means budgeting for medication, the treatment itself and limiting the number of patients treated - all for a fee that cannot maintain the high standard of the HZV. "For this reason, the association of general practitioners is demanding higher fees for those General practitioners in Bavaria: With the new planned protest campaigns and the system exit, the doctors' representatives want to force the health insurance companies to negotiate new contracts in health care. "The patient would benefit from a significantly better quality of care if he was guided through the complicated health system with the help of a qualified family doctor. The family doctors would therefore remain partners with AOK Bayern." However, this is only possible within the framework of the applicable laws "Said the AOK boss. On di On this basis, the AOK Bayern continues to offer its collaboration in family doctor-centered care.

At the same time, the head of the health insurance fund emphasized that he had "no understanding" for the fact that family doctors in Bavaria, of all things, are starting such a dispute. Because the case value, i.e. the turnover per patient, is very high for Bavaria's doctors in a national comparison. The average is currently around EUR 43 per quarter. The cash fee in Bavaria is 60 euros. AOK Bayern paid significantly more with over 80 euros, said the cashier Platzer. (sb)

Also read:
The majority of patients do not know their rights

Image: Andreas Morlok / pixelio.de

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