Refusal by health insurance, - can Jobcenter help?

[soandso]

Is there a paragraph - under which, - one could apply for payment of cannabis treatment - by the Jobcenter?

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[MonaLisa]

Is there a paragraph - under which, - one could apply for payment of cannabis treatment - by the Jobcenter?

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Not to my knowledge. I would ask directly at the Jobcenter, they should know best.

[littleganja]

Is there a paragraph - under which, - one could apply for payment of cannabis treatment - by the Jobcenter?

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No! If you want to have the costs paid you have to apply for reimbursement from the health insurance. The job center is not responsible for this, you have to discuss this with your doctor!

[soandso]

Is there a paragraph - under which, - one could apply for payment of cannabis treatment - by the Jobcenter?

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No! If you want to have the costs paid you have to apply for reimbursement from the health insurance. The job center is not responsible for this, you have to discuss this with your doctor!

Really?

How do you know?

Did you ask the Jobcenter?

Are you Hartz IV?

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(I wrote in the subject line that there was a refusal of the health insurance. Or is it not clear?)

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[littleganja]

Really

I know it because it is so, if you have a claim to performance in terms of cannabis, then the health insurance. Somewhere in the Alg2 regulations, is synonymous with what the Job Center is liable to pay. Keyword: extra demand (Mehrbedarf)!

And no I do not get any services from the Jobcenter, which does not necessarily say something about the knowledge.

What prevents you from asking yourself in the job center? Or ask your doctor, you need the recipe anyway!

[MonaLisa]

Really

I know it because it is so, if you have a claim to performance in terms of cannabis, then the health insurance. Somewhere in the Alg2 regulations, is synonymous with what the Job Center is liable to pay. Keyword: extra demand (Mehrbedarf)!

And no I do not get any services from the Jobcenter, which does not necessarily say something about the knowledge.

What prevents you from asking yourself in the job center? Or ask your doctor, you need the recipe anyway!

Eine ausgesprochen geduldige Reaktion. Mir hats schon wieder gereicht...

[littleganja]

Wenn man keine Ahnung hat muss man halt fragen und wenn man der deutschen Sprache nicht mächtig ist und Bürokratie ein Fremdwort ist, warum sollte ich dann ausfällig werden? Der Punkt ist bei mir erst überschritten wenn man versucht mich zu verarschen, dann kann ich für nichts mehr garantieren.......
Daher blöde Fragen gibt es nicht, es gibt nur unverschämte oder beleidigende Fragen und das empfinde ich hier nicht.

[MonaLisa]

Wenn man keine Ahnung hat muss man halt fragen und wenn man der deutschen Sprache nicht mächtig ist und Bürokratie ein Fremdwort ist, warum sollte ich dann ausfällig werden? Der Punkt ist bei mir erst überschritten wenn man versucht mich zu verarschen, dann kann ich für nichts mehr garantieren.......
Daher blöde Fragen gibt es nicht, es gibt nur unverschämte oder beleidigende Fragen und das empfinde ich hier nicht.

Ich fand es schon ziemlch dreist. Aber da es um Dich geht und Du es anders siehst, habe ich meine Antwort wieder entfernt.

[PatientZero]

By the way, if you receive a negative response from the Krankenkasse/Health Insurance you should file an objection immediately. Plus you should concentrate "working around" the rejection instead of looking for another way (which really doesn't exist). Not sure, maybe you did this already, but this should be the way to go if you need long-term treatment for your disease.

Good Luck, and get well soon.

[soandso]

Really

I know it because it is so, if you have a claim to performance in terms of cannabis, then the health insurance. Somewhere in the Alg2 regulations, is synonymous with what the Job Center is liable to pay. Keyword: extra demand (Mehrbedarf)!

What prevents you from asking yourself in the job center? Or ask your doctor, you need the recipe anyway!

"littleganja"

Thanks for writing.

Could you please elaborate about those two statements? - I'm not sure I know what you mean.

1. "if you have a claim to performance in terms of cannabis, then the health insurance".

2. "Somewhere in the Alg2 regulations, is synonymous with what the Job Center is liable to pay. Keyword: extra demand (Mehrbedarf)!"

Yes, I do have the prescription, and also the receipt for the payment for the medication. - (I'm already using it, with a great success).

Thanks again.

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[soandso]

By the way, if you receive a negative response from the Krankenkasse/Health Insurance you should file an objection immediately. Plus you should concentrate "working around" the rejection instead of looking for another way (which really doesn't exist). Not sure, maybe you did this already, but this should be the way to go if you need long-term treatment for your disease.

Good Luck, and get well soon.

"PatientZero"

Thanks for writing.

Yes, of course I will work on - "working around the rejection", - meaning to oppose the rejection. -

And I'm not really "looking for another way", - but my logic tells me that Hartz IV people have an - additional relief, - merely in the financial level. - (At least until the health insurance approval, for example).

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[Harro]

I hope you have a translator, because german bureaucrasy can be very difficult to understand, even for germans.

Your main and in most cases only chance for a cost compensation is your health care provider.

If they refuse the usual answer to it is an objection and then a complaint, i.e. law suit. We can only strongly advise that you move in that direction because your other possibilities if you can't pay for Cannabis yourself are extremely limited.

In the Hartz IV legislation, there is such a thing called "Mehrbedarf" as indicated by previous posts in this thread. The legal text refered to is found in § 21 SGB II, section (6), that says:

"(6) Bei Leistungsberechtigten wird ein Mehrbedarf anerkannt, soweit im Einzelfall ein unabweisbarer, laufender, nicht nur einmaliger besonderer Bedarf besteht. Der Mehrbedarf ist unabweisbar, wenn er insbesondere nicht durch die Zuwendungen Dritter sowie unter Berücksichtigung von Einsparmöglichkeiten der Leistungsberechtigten gedeckt ist und seiner Höhe nach erheblich von einem durchschnittlichen Bedarf abweicht."

In my view this is the only chance you could persue, and it is very slight, i warn you.

Translated this means roughly:

"The benificiary (of Hartz IV benifits) shall be recognized an "additional demand" (=Mehrbedarf) insofar in a particular case there is an unavoidable, ongoing, recurring need. This "additional demand" is unavoidable, provided it is not met by third party benificiaries and under allowance of cost-saving opportunities of the benificiary (of Hartz IV benifits) and provided the demand is considerably higher in its extent than average demands."

The problem and reason why your chances for this specific legal norm to come in effect is that in almost every case your jobcenter will contend, that this additional demand for the costs of medical cannabis therapy can in fact be met by your health provider (third party), and - if it is not - your jobcenter will almost certainly allege that your medical affliction does not meet the medical requirements for treatment, based on health insurance law and hence is not a financial demand at all.

This is why we urge you to contest the health insurance's refusal, as this will be your most likely way to gain cost approval in general and your most promising time-investment overall.

I hope this helps.

Kind regards,
Harro

P.S. If you contest the insurance company's refusal and persuit a lawsuit there is a way to possibly get a priori cost approval for the time of the law suit, I think it's called "Einstweilige Verfügung". You might want to have a look at that.

[soandso]

"Harro"

Thanks for writing, - and for the detailed explanation. - I appreciate it a lot.

Just to make clear, - I'm going in both routes - in parallel. - The health insurance & the Jobcenter. -

One doesn't come instead of the other. (As long as the rejection of the health insurance is in place).

They are both different in nature & in essence.

The sentence:
"provided it is not met by third party", -

Means:
That one can actualy claim for - "Mehrbedarf nach § 21 Abs. 6 SGB", - only - following - a rejection - of the health insurance.

Therefore, an indication for a fundamental differentiation, - as opposed to the redundancy - which you suggested.

The nature of "Mehrbedarf nach § 21 Abs. 6 SGB" - is social & economical - in humanitarian sense, - which has a different attitude & requirements than the norm. -

On the contrary, - it is in-fact intended & put in place - in order - to equalize - the need of the disabled - to - the norm. - (In a sense). -

That's the whole point of those kinds of laws & paragraphs.

The intention of this paragraph is to allow a person without means, - (more or less) - the same opportunity as of a person - with means, - who can afford the medication (in this case), - even after rejected by the health insurance.

Of course there are conditions to be met by this paragraph too, - but in a totally different manner & attitude & wheight - than in the norm. -

(The "norm" being the health insurance, in this case)

Otherwise there wouldn't be a sense or a purpose - to the existence of such a paragraph, - at all.

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[soandso]

I hope you have a translator, because german bureaucrasy can be very difficult to understand, even for germans.
...
...medical cannabis therapy can in fact be met by your health provider (third party), and - if it is not - your jobcenter will almost certainly allege that your medical affliction does not meet the medical requirements for treatment, based on health insurance law and hence is not a financial demand at all.

Just to make myself clear, -

For this kind of redundancy, - and for the deeply rooted - incomprehension of how the law works, - by the vast majority of the Germans, - there - is - no - t r a n s l a t o r.

(And no cure)

Just the same that one can not unlearn his knowledge of the German language, - which is another good reason - not to learn it - to begin with, - "at all".

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[soandso]

...
This is why we urge you to contest the health insurance's refusal.

In-fact, - if my head is still in the right place, - as long as one is Hartz IV, - and is being refused by the health insurance, - the court by itself - will enforce to exhaust - first - "Mehrbedarf nach § 21 Abs. 6 SGB", - before - contesting the health insurance.

And again, - for the same - humanitarian & welfare - p r i o r i t i e s.

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