How do I apply for pulmonary rehabilitation in Germany?
How do I apply for pulmonary rehabilitation in Germany?
For people with chronic obstructive pulmonary disease (), even everyday activities can become very difficult. If symptoms remain undiminished even with appropriate treatment, and it is hardly possible to take part in public life, pulmonary rehabilitation can be an option.
This type of rehabilitation aims at better managing the disease and at living as normal a life as possible. This information aims to help you if you decide to apply for pulmonary rehabilitation, and explains who will be the right person to contact and when.
Your doctor will assess whether you need pulmonary rehabilitation, and also let you know which documents you need for the application. Generally, the following are needed:
The application for rehabilitation for the insurance company that pays for it
The examination report (if the rehabilitation is paid for by the pension insurance) or a medical prescription (if the health insurance is responsible)
Which institution pays the costs of the pulmonary rehabilitation, depends, among other things, on the goals of the rehabilitation:
Statutory pension insurance (gesetzliche Rentenversicherung, GRV): Statutory pension insurance usually covers the costs when you are working and the aim is to avoid early retirement, for example.
Statutory health insurance (gesetzliche Krankenversicherung, GKV): Statutory health insurance pays the costs, for example, if someone is not working and the aim is to prevent the need of nursing care.
Other insurances: In fewer cases, other insurances pay the costs, for example statutory accident insurance (gesetzliche Unfallversicherung, GUV) if an accident was the reason rehabilitation is needed.
Private health insurance (private Krankenversicherung, PKV): People with private health insurance can consult their insurance policy to find out whether and to what extent a rehabilitation program is covered.
You will then send the application documents to the insurance that will presumably pay the costs. If the insurance you have contacted is not responsible, it will forward the application to the insurance that is.
If your application for rehabilitation is not accepted, you can appeal against the decision within one month – preferably together with the doctor who has recommended the pulmonary rehabilitation. If you give reasons for your appeal, the chances are higher that on the second attempt your application will be accepted.
Rehabilitation after a hospital stay: follow-up treatment
When symptoms suddenly get much worse, it is often necessary to go to the hospital. People who go to the hospital because of their disease suddenly getting much worse (exacerbation) are entitled to follow-up treatment (Anschlussheilbehandlung, AHB). This is also called follow-up rehabilitation.
Follow-up treatment does not differ from “normal” rehabilitation as far as what is done. The only difference is that follow-up treatment – as the name suggests – immediately follows a hospital stay and already has to be applied for while in the hospital. The application for follow-up treatment is filed by the hospital social service or the hospital doctors treating you.
Finding a suitable clinic
Generally, everyone has the right to choose a rehabilitation facility. The decisive factor is that the rehabilitation clinic is specialized and can offer qualified pulmonary rehabilitation to people with . The insurance companies have made contracts with many facilities. These facilities meet quality standards that are important to the insurance companies that pay for the rehabilitation. If you are looking for a rehabilitation facility, you can directly contact your insurance company or consult your doctor. You can also get help by using internet search engines.
If you name your preferred facility in your application, the insurance company checks whether it can accommodate you.
Additional costs and compensations
During pulmonary rehabilitation, an additional payment of 10 euros/day will often be required. It depends on your insurance whether you have to pay these extra charges. They also depend on whether you receive inpatient or outpatient treatment and whether you have already made additional payments in the same calendar year, for example because of a hospital stay.
If an additional payment imposes an unreasonable burden, you can apply for reduction or exemption. Your insurance company can provide you with up-to-date information on additional payments.
If you are employed, you will have to stop working during rehabilitation. At first, employees are entitled to receive their usual pay during this time. If this entitlement has already been used up, the insurance provides compensation for reduced income. Your insurance companies will have more information about this.
What happens after rehabilitation?
Generally, pulmonary rehabilitation is approved for three weeks to start with. If it turns out that it is necessary to stay longer, this can be applied for during the ongoing rehabilitation. It is also possible to take a vacation directly after rehabilitation. If you have enough vacation days left, your employer has to approve. Rehabilitation itself does not count as vacation days, but as inability to work.
You can take part in pulmonary rehabilitation more than once. But in general, doing pulmonary rehabilitation is only possible every 4 years. If there are medical reasons – for example, if the suddenly gets worse – it is also possible to do another pulmonary rehabilitation earlier than this.
It is not always necessary to do a complete rehabilitation, however: many measures – such as doing walking or participating in a lung sports group – can be taken at home or close by, and can be well integrated in everyday life.
IQWiG health information is written with the aim of helping people understand the advantages and disadvantages of the main treatment options and health care services.
Because IQWiG is a German institute, some of the information provided here is specific to the German health care system. The suitability of any of the described options in an individual case can be determined by talking to a doctor. informedhealth.org can provide support for talks with doctors and other medical professionals, but cannot replace them. We do not offer individual consultations.
Our information is based on the results of good-quality studies. It is written by a team of health care professionals, scientists and editors, and reviewed by external experts. You can find a detailed description of how our health information is produced and updated in our methods.
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