[Identification of medically unnecessary benefits by consultants in insurance medicine saves millions].
A medical consultant advises his company such that the persons insured receive the medically necessary benefits agreed in their insurance contract and thus are offered very good medical treatment. But it is also in the interests of all those insured to identify those treatments that are neither indicated, effective, nor medically necessary, as well as treatments which may prove dangerous to patients or result in overtreatment. Based on a representative sample, the present study examines which sums are not reimbursed due to this approach. The medical fields to be considered in particular are also addressed. It was found that the medical necessity of artificial insemination, alternative treatments, medications, innovative treatment methods and debatable cosmetic treatments, and certain other fields of consultation, would be worth investigating in particular. About 7 million € could have been saved in 2014 as a result of the advice from the medical consultant.
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Hakimi
D017046:Cost Savings / Q000191:economics*; D005858:Germany; D017048:Health Care Costs; D007345:Insurance Claim Review / Q000191:economics*; D007348:Insurance, Health / Q000191:economics; D007349:Insurance, Health, Reimbursement / Q000191:economics*; D012017:Referral and Consultation / Q000191:economics*; D019564:Unnecessary Procedures / Q000191:economics*