In a letter dated 23.01.2025, the working group of health insurance associations in the state of Brandenburg informed Gemeinnützige Rettungsdienst Märkisch-Oderland GmbH (GRMOG) that it will limit its obligation to provide services to all legally insured persons to fixed amounts with retroactive effect from 01.01.2025.
This means that the health insurance companies are leaving their policyholders out in the cold in an emergency! The reason given for this is that the health insurance companies do not accept the calculated costs of the emergency services and instead want to impose their own model.
This is wrong! The ambulance service provider/district is responsible for preparing the cost and service calculation.
No legal basis for limiting services to fixed amounts
There is no legal basis for this approach by the health insurance companies: the legal requirements for the fixed amount regulation (Section 133 Para. 2 SGB V) are not met - the OVG Berlin-Brandenburg recently explicitly stated this in its ruling on the fee statutes of the district of Märkisch-Oderland.
The fixed amounts represent a unilateral and arbitrary reduction in benefits by the health insurance companies vis-à-vis their policyholders. This de facto turns the insured persons into fee debtors towards the rescue service providers/districts through their own health insurance company, because the districts have drawn up their statutes in accordance with the Rescue Service Act and are bound by them.
This is not justifiable in terms of health and social policy and would effectively mean that medical rescue assistance in Brandenburg is now dependent on the respective wallet.
The state government is the legal supervisor of the health insurance companies in Brandenburg. It is now required to intervene and put an end to the unlawful practice of the health insurance companies.
For orientation: The fixed amounts for those with statutory health insurance have been communicated as follows:
The fees for rescue services are calculated to cover costs. This is stipulated by the law on the rescue service in the state of Brandenburg.
According to the current statutes on the charging of fees for rescue service services in the district of Märkisch-Oderland (RDGS), the fee notice is issued to the fee debtors (patients) if the health insurance companies refuse to pay in full or in part.
Retroactively to the introduction of the fixed amounts in relation to those with statutory health insurance, the patients concerned will receive a fee notice from GRMOG for the difference to the statutory fee amount.
The Brandenburg Rescue Services Act regulates the mandatory transfer of tasks of the rescue service to the districts and the cost recovery principle by the health insurance companies. It pursues the goal of a nationwide rescue service financed on the basis of solidarity.
The Ministry of Health and Social Affairs is the legal supervisor of the health insurance companies. It must therefore intervene if legal requirements are undermined. This is urgently required!
The district of Märkisch-Oderland and GRMOG regret this unnecessary escalation in cooperation with the cost bearers and in particular the uncompromising attitude of the health insurance companies.
What can citizens do now?
The only way is to submit the ambulance service fee notices to the health insurance companies. If they refuse to pay, it is inevitable that the insured person will take legal action against their health insurance company. We, the district of Märkisch-Oderland and the non-profit rescue service Märkisch-Oderland GmbH, will support the citizens in the necessary legal proceedings and provide legal assistance.
The district really regrets this situation and hopes for a quick settlement!
Important appeal: In an emergency, always call 112!
Despite the current disputes between health insurance companies and districts, one thing must never be called into question: medical care in emergencies.
Independent of financial or organizational discussions, the following applies: in acute health emergencies, do not hesitate - call 112! Every second counts, and the emergency services are ready to save lives.
Please don't let yourself be unsettled and act responsibly - for yourself, your family and everyone around you.