The radiologie.zentrum.nordharz in Goslar refused MedLabPortal editor and journalist Marita Vollborn a medically prescribed MRI examination arranged by the KVN (phone number 116 117) via urgency code , after this had been previously promised. Bizarre reason from Goslar: The management had decided this way. Reason: None. Information on the names of the “decision-makers”: None. To what extent the rejection could have something to do with the patient’s journalistic work, and whether media people have to fear for their health care, we wanted to know from the Lower Saxony Ministry of Social Affairs, Labour, Health and Equality – and also what rights patients have in such cases.

MedLabPortal: Is it legally permissible for a radiology practice to reject patients for personal reasons after a confirmed appointment? What is the legal basis for such a decision?

Ministry: In general, the principle of freedom of occupation applies, i.e. except in emergencies, doctors are generally free to decide whether to treat patients or not. However, panel doctors or statutory health insurance physicians who are licensed by the Association of Statutory Health Insurance Physicians generally have a duty to treat a patient with statutory health insurance. This obligation is regulated in Book V of the Social Code (§ 95 para. 3 sentence 1 SGB V) and in the Federal Umbrella Agreement for Physicians (BMV-Ä). The doctor can only refuse to treat a health insurance patient on the basis of a justified case (in particular § 13 para. 7 sentence 3 BMV-Ä), e.g. if the relationship of trust between him and the patient is disturbed.

MedLabPortal: What specific patient rights do people with statutory health insurance have in the context of a medically prescribed MRI examination – especially after mediation by the appointment service point of the Association of Statutory Health Insurance Physicians?

Ministry: The entitlement to the MRI examination itself depends on the medical necessity determined by the referring physician. Without a valid referral, a radiology practice cannot bill the examination through the health insurance company. After an appointment has been arranged by the appointment service center, a treatment contract is concluded with the radiologist. As a matter of principle, the radiologist may not refuse treatment without a specific, medical or behavioral reason (such as a disturbed relationship of trust).

Sollte die Radiologie-Praxis den Termin, der über die Terminservicestelle vermittelt wurde, ohne konkreten Grund ablehnen, haben Patientinnen und Patienten die Möglichkeit, die Terminservicestelle zu kontaktieren, um den Vorfall zu melden. Bei wiederholter oder ungerechtfertigter Ablehnung kann eine Beschwerde bei der Kassenärztlichen Vereinigung Niedersachsen (KVN) eingereicht werden. Die Kassenärztlichen Vereinigungen sind als Körperschaften des öffentlichen Rechts u.a. für die ordnungsgemäße Durchführung der vertragsärztlichen Versorgung verantwortlich. Hierzu zählt auch, die an der vertragsärztlichen Versorgung teilnehmenden Vertragsärztinnen und Vertragsärzte – ggf. mit Disziplinarmaßnahmen – zur Erfüllung ihrer Behandlungspflicht anzuhalten.

Health insurance companies can also help find a solution. In addition, the State Patient Protection Commissioner advises patients and their relatives on fundamental questions of medical care and on the exercise of their rights.

MedLabPortal: Are there any special safeguards or recommendations for patients who have reported critically on medical procedures or products in the past to prevent discrimination by healthcare providers?

Ministry: The aforementioned protective mechanisms apply to all patients in Lower Saxony. There are no special regulations for patients who have reported critically in the past.

MedLabPortal: Which complaints and arbitration offices can affected patients use in the event of an arbitrary rejection by a practice, and how is the further procedure regulated?

Ministry: See answer to question 2.

MedLabPortal: What findings or statistics do you have about the exclusion of critical or investigative journalists from statutory health insurance services?

Ministry: The Lower Saxony Ministry of Health has no findings on this.

MedLabPortal: What role do the Association of Statutory Health Insurance Physicians and the Ministry of Health play in ensuring that all people with statutory health insurance have non-discriminatory access to medical care?

Ministry: In Germany, nationwide regulations and the principle of self-administration apply in the area of statutory health insurance. This means that the federal legislature provides the legal framework and the health care providers are responsible for ensuring health care.

The KVN is responsible for the nationwide outpatient care of the population in Lower Saxony close to home. The Ministry of Health of Lower Saxony has legal supervision over the KVN and in this context must examine whether the KVN complies with the law and other law that applies to it. In addition, the ministry can provide support with the staff unit of the State Patient Protection Officer, which was established in 2016.

MedLabPortal: Thank you for your time.

The questions were asked by Marita Vollborn

Further information:

116117 appointment service: Book doctor’s appointments online for people with statutory health insurance – 116117.de

Editor: X-Press Journalistenbüro GbR

Gender Notice. The personal designations used in this text always refer equally to female, male and diverse persons. Double/triple naming and gendered designations are used for better readability. ected.