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The State Flips You Off – You Only Have a Right to Basic Needs – Which Politician Will Show Solidarity?Another Episode From the Series: Stories Written by Life – Or Rather by Administrations and Institutions. 
What’s This About? I’ve hinted at it here and there before. I have a daughter with a disability who relies on a wheelchair. That sounds very mild when, in fact, walking and many other things are impossible. The condition is called spinal muscular atrophy. There is no cure. The condition deteriorates gradually. Life expectancy is limited. To be able to travel longer distances, a car is necessary. Since the wheelchair has to come along, a compact car isn’t sufficient. If more than two people (family) are to ride along, even a station wagon becomes tight. Because the wheelchair is not foldable (a foldable one would be uncomfortable), a vehicle is needed that allows for a practical solution. So, a minivan or – in modern terms – a van. We've been driving such models for a long time. Anything else is just a torment, because it's utterly impractical. Our daughter reached adulthood a few years ago and has also gained weight. The last measurement showed just under 60 kilograms. The problem, therefore: who – and how – lifts such a person into the car? The knees cheer, and the spinal discs rejoice. The next topic is the electric wheelchair. That’s a case for bodybuilders, as it weighs 130 kilograms. So, a practical solution is needed: a wheelchair ramp and a seat in the car that can extend electrically, so that getting the daughter into the car doesn’t cause a slipped disc. Since the previous van had already celebrated its 10th birthday and such an installation is supposed to be used for many years, everything we had was scraped together to buy a new one. Yes, this time new, not used – because it should run for at least another 10 years – without rust, without constant issues. It wasn't a Mercedes, VW, or Ford, but a Citroën. No extra-cost paint, no leather, no luxury – and still it was 40,000 euros, with all possible discounts. Citroën offered no discounts for people with disabilities. Then it was time to file an application with the health insurance provider to finance the ramp and the seat. The cost estimate was 12,000 euros. And, as is typical with expensive requests, many weeks passed before a response came from the insurer. And, as is also typical, the request was denied. The reasoning again shows what support looks like in this country for people who unfortunately need help. The full text follows further below. The State Flips You OffThe health insurance writes, among other things, that assistive devices must “not exceed the necessary level.” An assistive device is “necessary within the meaning of the mentioned regulations if its use is required for life activity within the framework of general basic needs. General basic needs include everyday activities such as walking, standing, grasping, seeing, hearing, eating, excreting, and elementary personal hygiene, as well as gaining a certain physical and mental space, which also includes receiving information, communicating with others...”Great, isn’t it? There used to be something about the right to self-determination and participation, which people with disabilities are supposed to have. But that, once again, doesn’t matter. According to the health insurance provider, using a car is not a basic need. Their standardized text assumes that our daughter wants to drive the car herself. That was never stated in the application and is not the goal. Well, it’s always helpful in denying applications if the authority misinterprets them. Makes the rejection easier. Also delightful: “The general basic need to walk independently is not to be understood as obligating the health insurance to enable a disabled person to cover distances of any kind and length by providing assistive devices. For walking, the relevant vital needs include only the ability to move within one’s home and to leave it for a short walk ‘to get some fresh air’ or to reach – typically nearby – places to handle everyday matters. This applies even if, in individual cases, these places are not nearby and longer distances must be traveled.” Basic compensation for the walking disability is ensured by the existing wheelchair. So what does that mean? A wheelchair user is only allowed to move around their immediate neighborhood. Anywhere else? Not necessary! Visiting relatives? Nope! Seeing something different for a change? Nope! Spontaneous activities because the weather is nice? Nope! Things that are completely normal for everyone else? Nope! The application clearly stated that longer trips are repeatedly necessary. The University Hospital in Leipzig requires check-ups at least once per quarter, so that the medication that slows the progression of the disease can be prescribed. This and other doctor visits were generously omitted from the standardized text. Weekly therapies? Also ignored. Seems those aren’t important to the health insurance provider – or are they? Conspiracy Theorist – Because I KnewRemember those wonderful pandemic years? Suddenly, health and every single life were super important. Lockdown, testing frenzy, mask hysteria, vaccine mania – money was no issue. Billions and billions were available.Or hundreds of billions for weapons and military buildup, to kill people – also no problem. Are those the basic needs of the citizens? Would an application for a self-propelled howitzer have had more success than one for a wheelchair ramp and car seat? But oh, how I was attacked back then when I warned against getting the miracle cures (some call them vaccines). They hadn’t been tested, and side effects were predictable. People told me the state would take responsibility in case of side effects. Well, I already knew how this “responsibility” looks. Just like this. The state does not take responsibility. The state flips you off! The state – in this case the health insurance – covers only basic needs. A roof over your head, washing, eating, pooping, media consumption. That’s all a human needs. If you suffer from a nasty disease, you get the medically necessary things. Not the best, not the optimal – no, just the bare minimum. But none of the measure-huggers and vaccine worshippers wanted to believe me. That makes you a conspiracy theorist real fast. Those who have now experienced it themselves probably see it differently. The health insurance refers us to the social welfare office. We've already had plenty of “fun” with that agency. There, you don’t get just one, but two middle fingers. Sounds harsh – but that’s the reality. Who Will Show Solidarity?Remember how important it was to be in solidarity – with the elderly, the disabled? You, who complied with everything, you politicians who outdid each other with restrictions in the name of containment: What about your solidarity now? Just scroll down – there's a bank account listed so you can show plenty of solidarity. Thanks in advance.File an Appeal? Yes! Success? Probably None!We will file an appeal, but the chances of success are likely close to zero. On one hand, the health insurance will cling to court rulings; on the other, if legal action is needed, the process could drag on for years. The state doesn’t care. The state likes to play the long game.In the following video, those interested can see what this all looks like. The title “Poor Despite Working” is absolutely accurate. Two women with the same condition are shown. One of them is even a judge – she knows the system – and still had no chance. That was 11 years ago. Nothing has changed since. Be in Solidarity – Now!So, dear folks, dear politicians who love to talk about social justice, solidarity, community and all that: Be in solidarity – preferably in the four-digit range. Oh, and please hurry – because of the knees and spinal discs.The Health Insurance's Standard Text: ... we received your application. We cannot cover the cost of this assistive device because: According to § 33 (1) of the Social Code Book (SGB) V, insured persons are entitled to visual and hearing aids, prosthetic limbs, orthopedic and other assistive devices that are necessary in individual cases to ensure the success of medical treatment or to compensate for a disability, as long as the devices are not considered general everyday items or are excluded by a regulation issued by the Federal Ministry of Health. When providing assistive devices, the principle of cost-effectiveness under § 12 (1) SGB V must also be observed. Benefits must be sufficient, appropriate, and economical; they must not exceed what is necessary. Benefits that are not necessary cannot be claimed by the insured, and service providers and insurers are not allowed to approve them. According to a ruling by the Federal Social Court (BSG) on 16.09.1999 - B 3 KR 13/98 R - an assistive device is necessary if its use is required for life activities within the scope of general basic needs. General basic needs include daily activities such as walking, standing, grasping, seeing, hearing, eating, excreting, and elementary personal hygiene, as well as gaining a certain physical and mental space, including receiving information, communicating with others, and learning essential basic knowledge (school knowledge). Although using a vehicle can mitigate the effects of a disability, especially in terms of social participation (e.g., attending private or public events) and leisure (e.g., theater, cinema, sports events), driving a vehicle is not a basic need under the law, according to the highest courts. In the case of loss of walking ability, statutory health insurance is only responsible for basic compensation. The general basic need to walk independently is not to be interpreted as requiring the health insurance provider to enable the disabled person to travel distances of any kind or length. Vital life needs in terms of walking only include the ability to move within one's home and to leave the home for a short walk “to get some fresh air” or to reach nearby places to handle everyday matters. This also applies if, in individual cases, these places are not nearby and longer distances need to be covered. Basic compensation for your walking disability is ensured through the existing wheelchair. Support for general social integration can be provided, depending on the cause of the disability, by accident insurance providers and war victims’ support agencies, or otherwise by social welfare agencies. We regret that we cannot accommodate your request. However, we are bound by the legal provisions and the case law of the social courts in our decisions. We therefore cannot approve your application. If you have questions about this letter, please call us at 03445 261460. Mention the keyword “assistive device consultation” and your insurance number B 704 833 090. We are also happy to advise you via video at www.dak.de/videoberatung. Kind regards Your DAK-Gesundheit Author: AI-Translation - Michael Thurm | |
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