Cash registers: External consultants for the mentally ill

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Health insurance companies rely on external counselors for the mentally ill because of expensive sick pay

Health insurance companies are increasingly using external consultants to care for mentally ill people. Doctors and data protection officers see problems in this new business model.

Discussions with external consultants are voluntary. Increasingly, employees on sick leave receive mail from their health insurance company with an invitation to a "counseling meeting on health management", which should not take place at the fund itself but at a private service provider such as Ge.on Case Management. The consultations with companies that are commissioned by the health insurances to look after mentally and chronically ill people are voluntary. Even if no insured person can be obliged by their insurance fund to take part in these discussions, very few refuse. According to the head of Ge.on Case Management, Susanne Jacobs-Finkelmeier, this is only done by a minority: "90 percent of the insured persons addressed by the health insurance company are involved and are grateful for our offer." According to Jacobs, the company looks after around 10,000 people annually -Finkelmeier were initially only suspicious and would then be persuaded and stay.

Health insurance companies want to get rid of the handicapped and chronically ill In the past few weeks, the way health insurance companies deal with mentally ill people has come under fire. There was talk of clerks who would put massive pressure on them, who would terrorize the telephone and intimidate them. According to a report by the Federal Insurance Office (BVA), attempts were also made to force the disabled and patients with long-term illnesses from the cash register by telephone. These funds received a clear reprimand. "The procedure outlined violates fundamental principles of the Social Security Code and does not do justice to the responsibility of statutory health insurance funds, especially when it comes to medical care for disabled and chronically ill people," the report's authors complained.

Sickness benefit should be saved All of this was done against the background of costs. Employees on sick leave generally receive continued payment of wages from their employer for the first six weeks and then sick pay from the health insurance company. Its amount is based on the last salary received. Especially with mental illness, there is often a long period of inability to work. Depression caused by stress, for example, has increased significantly in recent years and is causing numerous days off. Nationwide, an estimated 2.2 million people a year are unable to work due to mental illness. The number of cases has increased by almost 150 percent in the past 15 years.

No pressure on the mentally ill In the meantime, almost all health insurance companies have hired sickness benefit managers, and in most cases entire departments are responsible for these particularly costly insured persons. At the same time, a branch of service providers has established itself across the country, some of which advertise themselves to the health insurers by bringing mentally ill people back to work and thus getting them out of sick pay. According to Jacobs-Finkelmeier, however, no pressure should be put on the insured. "We want patients to get everything they need to get well," says the company boss. Your staff - psychologists, social pedagogues and doctors - would work closely with the doctor treating you. "The impression of the medical layperson is: You have to put pressure on the mentally ill, then it will work again," says the entrepreneur. But this "only achieves the opposite."

Skepticism about the work of the service providers In addition to the cooperation with the doctors, your company is also looking to work directly with the patient on his problems. For example, consultants could help resolve conflicts in the workplace and seek discussion with colleagues or superiors. However, many doctors and patient advocates are skeptical about the work of these service providers. Claudia Schlund of the Independent Patient Counseling Center (UPD) criticizes: "This creates a subtle pressure on the patient" and further: "Many feel compelled to strip naked, to have to give everything up." According to her experience, many mentally ill people are not free to choose to speak to the advisors. "They are afraid of the Damocles sword performance cut and therefore participate."

Data protection officers concerned This criticism is not new to Ms. Jacobs-Finkelmeier, but she considers it to be unfounded. She would also know about health insurance companies that put insured people under pressure and have little interest in their recovery, but their company would not work with them. Another problem that is seen in the work of service providers is data protection. Because the companies collect a lot of personal information about the patients and exchange them with the health insurers. A spokeswoman for the Federal Data Protection Commissioner Peter Schaar says that it is still far from clear whether this practice is watertight, even if insured persons have to agree to this in writing: "There is no legal basis for this." She announces a thorough examination: "We will pursue. "(ad)

Image: Jack B. Maier /

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