What does suspension of proceedings mean?
The proceedings can be suspended both in the preliminary proceedings and in the legal action. In 2017 in particular, a suspension proposal was very popular with the health insurance companies, as a final decision by the Federal Joint Committee on liposuction in lipedema was expected on July 20.07.2017, 30.09.2022. As we know, the method evaluation process was suspended until XNUMX/XNUMX/XNUMX. In lawsuits often to federal committee to wait to be able to make a valid decision, a decision of the Federal Social Court or even the common.
Why is a dormant process not always so calm?
At issue here is the dormant procedure in the application process at the health insurance company.
Some patients accepted the suggestion to rest, others did not. For those who have refused to consent to the suspension of the proceedings, the rejection has not always been taken within the statutory three or five-week period. In this respect, the dormant process is not as calm as it might appear at first glance.
The fact that a fictitious approval can occur may seem astonishing here, but it can be deduced from the logic itself. A suspension of the procedure can only be proposed if no final negative decision has been made in this procedure. Even if a suspension agreement was concluded, considering the length of time the method evaluation was suspended, it would have to be checked whether there could really be an abuse of law if a fictitious approval was asserted.
Can that matter to me?
Anyone who had anything to do with the issue of the dormant agreement should check whether it was rejected and a notice of rejection was issued later than the statutory deadlines.
How do I calculate this again?
The day after receipt of the application by the health insurance company is decisive for the start of the period. Then calculate three weeks or five weeks if the MDK is involved. Example: Application received by the health insurance company on May 03.05.2017rd, 04.05.2017; The period starts on 24.05.2017 and ends on 07.06.2018 (in the three-week period) or at the end of XNUMX (in the five-week period).
Please also remember that a review is possible four years retrospectively.
With this in mind, more about this and many other topics on this blog,
Your Ruth Leitenmaier.