What is a claim assessment?
A claim assessment determines whether a medical condition existed before your policy began. This process can be triggered when certain claims or cost plans are submitted, especially 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 direct contact with your doctor regarding any concerns, and a standard health questionnaire asking about your medical history. You'll need to complete all questions.
Once filled out, we'll submit it for further review.
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 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 be a new confidentiality release form or health questionnaire.
This is a collaborative process and your support in reaching out to your doctor if they haven't responded is crucial for keeping the assessment moving efficiently.
Feather's role throughout the process
The review process, which depends on the response times of both you and your doctor, as well as the review itself, may take several months. We will keep you updated regularly via email to ensure the process moves forward smoothly.
Please note that progress reports cannot be provided until we receive feedback. However, we will keep you informed at every stage of the process, from start to finish.