>> In Germany, around two million people suffer from chronic heart failure. The mortality, the suffering and the reduction in the quality of life of those affected are high. And medical care for this group of patients costs around three billion euros per year; mainly caused by hospital treatment (1). The National Care Guideline for Chronic Heart Failure therefore recommends structured telephone support and telemonitoring for patients with an increased risk of mortality or hospitalization, as participation in telemedicine programs can lead to a demonstrable reduction in mortality and the number of hospital days (2 ,3,4).
Now, however, the health insurance companies know very well that the participation rate is only 2% without primarily telephone information, but can rise to 20 or even 30% if primarily telephone information is used.
The supervisory authority justifies its ban by saying that telephone calls (including those from health insurance companies) are an unreasonable nuisance within the meaning of Section 7 Paragraph 2 UWG (“telephone advertising”). But: What does a telephone call with perhaps even vital information or the offer of a service that is absolutely useful for the individual patient have to do with advertising?
Now one can concede to the health insurance supervisory authorities that they have, with good intentions, prohibited contacting insured persons by telephone without prior written consent. They may have wanted to prevent activities that were primarily in the financial interests of the health insurance companies (e.g. sick pay management). But they didn't take into account that the insured themselves may have an interest in being protected from a deterioration in their health, for example if
• Patients at very high risk are discharged after hospital stays
• Life-saving care options would be available, but they are not yet being used
• Any problems arising in discharge management
• There is data-based evidence that drug therapy safety is at risk
• High-risk factors are present because people with existing previous and underlying illnesses have a significantly increased risk of a severe course of Covid-19 disease (WIdO, see p. 22).
In many cases, obtaining a written explanation may take too much time or may not be possible at all, preventing the information from reaching patients. Therefore, in order to possibly save human lives, there is an urgent need for clarification from the legislature: Insured persons have the right to be informed by their health insurance company about potentially life-saving care offers, including primarily by telephone. This could be a useful service provided by the health insurance company for its insured persons, which in no way represents an unfair commercial act within the meaning of the Act against Unfair Competition (UWG).
The Federal Association has already made a move in this direction and tried to incorporate it into the draft of the “Second Law for the Protection of the Population in an Epidemic Situation of National Concern”. The Association of Replacement Insurance Funds (vdek) (5) has commented on and also supported this proposal because, especially in the current Corona crisis, “it is becoming clear that the health insurance companies cannot provide insured people with specific health risks with timely and adequate advice and specifically offer suitable health services”.
That is why, in the opinion of the vdek, legal adjustments should be made to Section 11 SGB V in order to realize options for action in the short term. However, the vdek proposal, according to which health insurance companies should be able to provide insured persons with “specific advice on the existence of specific health risks and offer individually suitable health services as well as general and individual health care services as part of care management,” apparently went a little too far for the BMG, which was confronted with it and was not introduced into the pandemic legislative process that had just ended. Nevertheless, a solution should urgently be found in the coming legislative process. <<

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