Kostenübernahmebescheid

A Kostenübernahmebescheid, which translates to "cost assumption notice" or "cost approval notice," is an official document issued by a German statutory health insurance fund (gesetzliche Krankenversicherung or GKV) or a social insurance provider. This notice confirms that the insurance provider has approved and will cover the costs for a specific medical treatment, service, or product that is not automatically covered by the standard benefits catalogue.

These Bescheide are typically issued in situations where a patient requires a treatment, medication, medical device, or rehabilitation that is considered exceptional or requires individual assessment. For instance, a patient might need a highly specialized surgery, an expensive medication not on the standard formulary, or a prosthesis not commonly provided. The patient or their doctor must apply to the health insurance fund for approval, providing detailed medical justification.

The Kostenübernahmebescheid clearly states what costs will be covered, for what specific treatment or item, and often includes a validity period for the approval. It serves as a crucial document for both the patient and the healthcare provider, guaranteeing that the expenses incurred for the approved service will be reimbursed by the insurance. If the application is denied, a Widerspruch (objection) can usually be filed against the decision.