Again and again I am asked for the preparation of a report. I would like to give you some basic information.
In the question of whether a treatment was right, perhaps further therapies are necessary or a health insurance company refuses the reimbursement, there is sometimes disagreement.In all issues, I recommend to first seek the conversation with those involved, your own situation or the, your child and to look for a good solution for all sides. Frequently, misunderstandings can be cleared up in the conversation or questions can be clarified.
Sometimes it may be useful to have a neutral person (such as a friend, relative, or someone who is not directly affected) join you for a conversation.
All medical associations in Germany have mediation centers for assessing medical treatment. These often help to clarify inconsistencies or contentious issues and to find a solution. The procedure is basically free for patients, the costs are covered by the liability insurance. If no agreement can be reached here, you can still take all legal action. For more information, please contact the responsible medical association.
If no agreement can be reached, it may be necessary to submit an official statement. Here are several forms of medical opinion, which I will briefly outline below:
1. Second opinion
If you think there may be alternatives to a proposed treatment or you just want to hear a different opinion, you can contact a trusted doctor who works in the same specialty (for example, pediatrician). Bring, if possible, all the documents you have with you. Alternatively, previous findings can also be requested. The costs usually take over the health insurance companies.
2. medical report
For example, to apply for therapy or rehabilitation, it may be useful or necessary for you to submit a report on your child’s illnesses, limitations and / or problems, or they may be requested by the appropriate body.
As a rule, your pediatrician will issue this report, including the diagnosis and current therapy and, if necessary, a recommendation for treatment as your pediatrician considers useful.
The cost is around 20 – 50 euros and pays the one who commissions the report.
3. medical opinion
This is a detailed statement on treatment, including causes, circumstances, history, current therapy, prognosis, etc. This statement is intended to represent the disease comprehensively and neutrally, according to the medical standard, also on possible alternatives, risks, etc.
A medical opinion is often required by insurance companies, authorities, etc., in order to make a decision to reimburse the cost, usually it is created by the attending physician. The costs are around 100 euros and are borne by the client.
4. medical report
A medical appraisal deals in detail with a defined question, presents all relevant data / facts (in understandable German) and answers the given questions. In this case the assessor is obliged to neutrality, i. neither the patient’s interest nor the interest of the other party (doctor, insurance, authority, etc.) may play a role here. Essential are only the (documented) facts and the state of medical science.
It follows that the evaluator is neutral, i.e. usually is neither a doctor treating the patient, nor is he in a dependent relationship with the opposite party, i.e. not working in the hospital, who has carried out the treatment, does not work for the insurance, does not work for the appropriate authority, etc. Of course There must also be no family or close personal relationship with the participants.
The assessor must be or have been active in the area to be assessed and have a corresponding qualification, for example being a specialist in pediatric and adolescent medicine, possessing experience in intensive care medicine or the like.
In the medical field there is no explicit qualification or appointment / state. Recognition as a medical assessor, as provided for in other areas (construction, motor vehicles).
The medical report always refers to a specific question, e.g. In the case of the existing findings, the therapy performed was correct, as a rule, the questions to be answered are listed in detail in the report. Depending on the order, the patient may need to be examined or the report prepared as a report on the situation.
The assessor presents the course of the disease and answers the questions of the state of medical science, regardless of the interests of the parties involved or possible financial consequences, but according to purely medical criteria.
The evaluation of the opinion and further information and the decision, e.g. the customer then decides on the obligation to pay, e.g. the competent court.
The costs of a medical report are billed according to the law on compensation for damages according to expenses, the costs are borne by the client, they are usually at least 500 euros, one or several thousand euros are not uncommon.
If you would like to commission an expert report, you are welcome to contact me in advance to discuss the further procedure and to clarify the cost assumption.
Occasionally one reads, reports would only for the patient side or only for the medical side or insurance side or similar. created. However, opinions should not take into account or emphasize the interests of a party, but should be fundamentally neutral, i. according to the current state of knowledge take into account all facts, independent of individual interests.
As a rule, the result of an expert report can only be determined after a thorough review of all documents and, if necessary, additional research. Therefore, the result can not be pre-determined or an opinion with a specific result can be awarded in the order.
Possibly results can be discussed in advance, so that the report will only be awarded.