What’s that?
Health insurers are obliged to pay for health services not otherwise covered if their provision is the only option in terms of the insured person’s state of health. Unless it is an emergency situation, prior approval of the insurance company’s reviewing physician is required for reimbursement of such health care.
What could be the problem?
Health insurance companies often refuse to cover such services on the grounds that they are not the only treatment option for the insured. This assessment by the health insurer may not be correct. It is good to know that if all the legal requirements are met, the insured person is legally entitled to and can claim reimbursement for such care despite the insurance company’s contrary opinion. Thus, when submitting the application for approval of reimbursement (and subsequently throughout the approval process), it is important to bear in mind that the application must meet certain formal requirements and be carefully reasoned.
What can we help you with?
We are ready to help you both with the preparation of the application and in the subsequent steps if you face any complications or delays from the insurance company during the approval of the application. In this area, we provide legal services both for individual acts (e.g. preparation of arguments, preparation of statements or appeals in proceedings before the insurance company or in court) and it is possible to agree on legal representation throughout the process. We will agree with you the optimal strategy for dealing with the insurance company.
Who are our services for?
For anyone. We most often advise individual patients or their relatives, who are usually dealing with the issue of reimbursement for this type of medical service in a time-sensitive situation, and health care facilities in generally setting up their claims system to maximize their success rate.
How does it work?
Please leave your contact details in the contact form below. We will then contact you promptly to discuss how to proceed, depending on your specific needs. By submitting an enquiry you do not commit to anything.
Why choose us?
We are a law firm with many years of experience in health law and health insurance. We routinely deal with health insurance companies on behalf of our clients as part of our practice, so we are very familiar with the various situations you may find yourself in when dealing with a health insurance company. We also give public lectures on the issue of reimbursement of health services under Section 16 of Act No. 48/1997 Coll., on public health insurance.
We provide legal services as attorneys, we guarantee their quality and we are compulsorily insured in case of liability for damage caused by our activities.