What is a claim assessment?
A claim assessment determines whether a medical condition existed prior to the start of your policy. This process can be initiated when certain claims or cost plans are submitted, particularly for long-term treatments, complex therapies, or specific diagnoses.
In German, this is referred to as an APV-Prüfung (Anzeigepflichtverletzungsprüfung). It is a standard procedure among all German private health insurers, as outlined in your contract and supported by legal regulations (§ 19 Duty of Disclosure).
All claims affected by the assessment will remain unprocessed until it is successfully finalized. We will inform you of your coverage once the review is completed.
What does the process look like?
We'll email you a form to fill out.
The form consists of two parts: a confidentiality release, allowing the provider to contact your doctor directly if needed, and a standard health questionnaire asking about your medical history. All questions must be completed in full.
Once filled out, we'll submit it for further review.
The provider will send a letter and medical questionnaire to your doctor and/or previous health insurer by post. Communication with your doctor through postal mail typically begins about two weeks after you submit the confidentiality release form. It's advisable to let your doctor know that your insurance provider will be reaching out with inquiries, and that their response is crucial for assessing your insurance benefits.
Depending on your doctor’s response, additional information may be requested from you. This could include a new confidentiality release form or an updated health questionnaire. We will let you know if this is the case.
Once all documents are received and submitted
The provider typically has up to four weeks to review the complete documentation and issue a resolution — provided no additional questions or requests come up during their assessment.
Ultimately, it is the policyholder’s responsibility to ensure that all required documents are obtained and submitted. Actively following up with your doctor — especially if there are delays — is key to avoiding unnecessary hold-ups.
Feather's role throughout the process
The review process can take several months and depends on timely responses from both you and your doctor, as well as the provider’s internal assessment timelines.
At Feather, our role is to support you throughout this process. We ensure that the documents you submit are complete and properly forwarded to the provider. We also keep you informed of important updates as they become available.
If there’s a delay or no response from your doctor, it’s important that you follow up with them directly to keep the assessment moving forward.
Once we receive any new information from the provider, we’ll update you accordingly and step in to escalate if necessary.