- Ambulance care services see supply at risk
In the German state of Saxony-Anhalt, mobile home care services and the AOK health insurance company are in dispute over the reimbursement of certain nursing services. According to the Federal Association of Private Providers of Social Services (bpa), which represents around 500 member companies in the state, including approximately 250 mobile home care services, the AOK has been withholding payment for these services for 20 months now. The bpa claims that when these services are provided to AOK insured patients, the overtime pay for nurses working nights, weekends, and holidays is not being reimbursed. A spokesperson for the bpa said that these companies are facing unpaid amounts in the five-figure range, which is "not something they can simply absorb." The bpa is calling on its members to protest outside the state parliament on Wednesday, when the social affairs committee will be discussing the topic of home care.
The AOK Saxony-Anhalt, the largest health insurance company in the state, confirmed the disagreement over reimbursement. "The current differences are based on a reimbursement claim made by the bpa in 2023, which was up to 50% higher than the reimbursements of other providers," explained an AOK spokesperson. "Despite repeated requests, the associations of private providers did not submit any documentation on their cost and revenue structures to justify this claim, and thus did not create the legally required transparency."
The arbitration ruling did not resolve all the issues. At the end of 2023, an independent arbitration procedure took place, in which the position of the health insurance companies was essentially confirmed. "In the course of this arbitration ruling, we have already increased the basic remuneration." However, there is still disagreement over the overtime pay. "These are formulated too vaguely in the arbitration ruling and allow for different interpretations," explained a spokesperson. Therefore, the arbitration ruling is currently being challenged, and social courts will have to decide the matter. All other substitute health insurance companies and guild health insurance companies are paying the corresponding overtime pay, according to the bpa. "The AOK health insurance company is ignoring mandatory guidelines for the remuneration of nurses, although the AOK nursing care insurance and all other insurance companies pay a remuneration to home care services for this," explained bpa state chairwoman Sabine Kösling. "This is a clear breach of law by the AOK health insurance company and endangers the care of patients."
- The bpa has escalated their dispute with The Commission, specifically referring to AOK Saxony-Anhalt, by urging their members to protest, as they believe the insurance company is failing to adhere to mandatory guidelines and underserving nursing companies for overtime pay.
- In response to the bpa's accusations, The Commission, represented by AOK health insurance, argues that the lack of transparency in their cost and revenue structures has prevented them from justifying the higher reimbursement claim made by the bpa, leading to disagreements over overtime pay.
