Incontinence of urine or bowel movements affects many people. Find out here what incontinence aids are available and when health insurance will pay for them.
The most important thing in brief:
- Incontinence aids are medical aids and therefore benefits of statutory health insurance.
- In order for your health insurance company to pay for your incontinence aids, you need a doctor’s prescription.
- Your health insurance company will give you the name of one or more contractual partners who can ensure the supply of incontinence aids.
- Specialist retailers are obliged to provide advice in person or by telephone.
- The legally required co-payment is 10 percent of the reimbursement amount or a maximum of 10 euros per month.
How Incontinence Aids Work
In the case of incontinence of urine and/or stool, there are aids that are financed by the health insurance company, so-called incontinence aids . These include absorbent incontinence aids that absorb and store urine or collect liquid stool.
Absorbent incontinence aids include:
- Pads that can be worn in tight-fitting underpants or in so-called mesh pants for fixation
- Resealable protective pants with Velcro or adhesive strips
- Incontinence underpants, so-called “pants”, which are put on like normal underwear
Absorbent incontinence products have a multi-layered structure: a soft inner fleece and absorbent and odor-binding materials prevent moisture on the skin and bind odors. Absorbent incontinence products also consist of a moisture-proof top layer and a breathable outer layer.
Incontinence aids enable participation in social life. This makes it all the more important that you find the right aids in good quality. When choosing the right incontinence product, it helps to consider the following.
Important are
- Size and weight
Incontinence aids are available in different sizes. What is the body type (e.g. waist and hip circumference) of the affected person? - Drinking quantity
How many liters does the affected person drink per day? - Absorbency
Incontinence aids are available in different absorbency levels. How severe is the incontinence? - Gender
Many absorbent aids are suitable for both men and women. However, there are also gender-specific aids. - Skin problems
Are there any skin problems? This can be crucial for the choice of material.
How do I apply for incontinence aids?
People with statutory health insurance are entitled to be provided with absorbent incontinence products. These are listed as product group 15 in the medical aid directory.
Important: In order to receive incontinence aids at the expense of health insurance companies, you first need a doctor’s prescription .
- Health insurance companies pay for incontinence aids if there is at least moderate (guideline value: more than 100 ml in 4 hours) urinary and/or fecal incontinence.
- The prescription should include the diagnosis, the name of the prescribed item, and the required amount or supply period . It is also important that the prescription states why the aid is required. For example, it can be explained that the incontinence aid is required for “participation in social life”. The more precise the doctor’s prescription is, the easier it is to obtain the required incontinence aid.
- If you need incontinence material on a regular basis, it makes sense to get a standing prescription from your doctor. The standing prescription for incontinence material usually runs for several months.
How is the supply provided?
People with statutory health insurance are entitled to adequate, appropriate and economical care that does not exceed what is necessary. This means that they have a legal right to individually required incontinence products in sufficient quality and quantity.
If you want a special incontinence product or a larger quantity than necessary, you will have to bear the additional costs yourself .
People with statutory health insurance can only obtain the incontinence products they need from service providers with whom their health insurance company has a contract . Service providers include medical supply stores and pharmacies.
After receiving the doctor’s prescription, you should contact your health insurance company . The health insurance company will provide you with addresses of medical supply stores or pharmacies that have concluded a supply contract with the respective health insurance company for the delivery of incontinence products. If your health insurance company only has one contract partner, you can only purchase the incontinence aids from this exclusive partner at the health insurance company’s expense.
Attention: Anyone who purchases an incontinence product from a medical supply store or other specialist retailer with whom there is no contract with their health insurance company must pay all costs that exceed the price agreed with the health insurance company’s contractual partner.
The medical supply store or pharmacy can normally only issue products on prescription that are included in the list of medical aids of the statutory health insurance companies or that meet the standard set out in the list of medical aids. If there are several models to choose from, you can test the different variants.
As a statutory insured person, you are entitled to
- Advice,
- adaptation and
- instruction
to the company that supplies them with incontinence products. The specialist retailer, eg the medical supply store, is obliged to find the right product with you. Therefore, the pads must be individually selected and adapted. The specialist retailers are obliged to offer personal or telephone advice to determine the individual care needs. They must also inform those seeking advice about the health insurance benefits. If customers so wish, they must also be advised at home.
You are also entitled to delivery in neutral boxes . The delivery quantity must correspond to your spatial possibilities. The contracting parties must generally adhere to the agreed delivery times of 24 to 72 hours. In addition, an advice hotline must be provided.
Good to know: If the products available to you as part of the standard care do not meet your individual needs for medical reasons, you should speak to your health insurance provider before purchasing the desired product yourself. A certificate from your treating doctor can also be helpful in such cases. In justified exceptional cases, health insurance providers can approve care that deviates from the standard needs.
However, if you want a higher quality incontinence product without medical necessity or would like to purchase a larger number of incontinence pads, you will have to cover the additional costs yourself.
Who covers the costs of incontinence aids?
The statutory health insurance companies cover the costs of standard provision of incontinence aids. Medical supply stores and pharmacies then settle the bill directly with the health insurance company. The provision of incontinence aids and thus also the costs are regulated in negotiated contracts, the so-called accession contracts.
The statutory health insurance companies then pay the amount agreed with the pharmacy or medical supply store. The billing is based on a monthly flat rate . You can ask your health insurance company about this monthly flat rate. It often ranges between 10 euros and 32 euros .
At their own request, the insured person can receive a higher quality supply of incontinence products. The difference between the health insurance reimbursement and the actual price, the so-called additional costs, are paid by those affected out of their own pocket . This additional payment should not be confused with the statutory co-payment (see next point).
How much is the additional payment?
The co-payment for medical aids is regulated by law. There is a special regulation for “medical aids intended for consumption”. These are medical aids that can only be used once – incontinence aids are one of them. Here the co-payment depends on the monthly requirement. According to this legal regulation, patients must contribute 10 percent or a maximum of 10 euros to the cost of the reimbursement amount for the monthly requirement.
An exception are children and young people up to the age of 18. They do not have to make any additional payments.
Help with problems
In the event of a conflict with the delivery company, customers should contact their health insurance provider immediately . The provider must ensure that the required service is provided and that its insured persons receive the necessary assistance at short notice and in the right quantity and quality.
If the situation cannot be resolved to their satisfaction, insured persons can also change providers. Most health insurance companies have contracts with several retailers. They must inform their insured persons of this.
