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Sociotherapy; information on the assumption of costs
Insured persons who are seriously mentally ill and are unable to access medical or medically prescribed services independently are entitled to sociotherapy.
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Procedure details
Description
Are you severely mentally ill and unable to make independent use of medical or medically prescribed services? If so, you are entitled to sociotherapy as a person with statutory health insurance.
Sociotherapy includes practical life instructions that enable you to make use of outpatient medical and psychotherapeutic services. The aim is to strengthen your personal responsibility so that you can manage without sociotherapeutic care in the long term.
Sociotherapy can be prescribed if it avoids or shortens hospital treatment or if it is necessary but not feasible.
For each case of illness, you are entitled to 120 hours of sociotherapy within three years. The health insurance funds conclude contracts with suitable persons or institutions for the provision of sociotherapy.
Requirements
- You have statutory health insurance
- You are unable to access medical or medically prescribed services independently due to severe mental illness.
- The service must be approved by the health insurance fund
Required documents
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Required Documents
- prescription
Fees
- If you are at least 18 years old and are not exempt from statutory co-payments, you pay a co-payment of ten percent for each calendar day.
- However, the co-payment amounts to at least five and a maximum of ten euros per treatment day
Legal bases
Appeal
You can appeal against the decision of the health insurance fund. If the appeal is not upheld, you can file a lawsuit with the competent social court.
Status: 14.01.2024
Editorially responsible for prodecure description: Niedersächsisches Ministerium für Soziales, Gesundheit und Gleichstellung
Source:
Federal Portal