Medical rehabilitation (rehab)

Following an illness or an accident, it can sometimes take a long time to get back to normal everyday life. If individual outpatient treatments are not having the desired effect, medical rehabilitation can help.

Rehab can also be considered in the event of chronic illness or a disability associated with severe restrictions.

Rehab has the following goals:

• To prevent a permanent need for care or imminent disability
• To permanently restore health following an illness or accident
• To help people who are chronically ill or disabled to live independently
• To help patients cope better with the consequences of an illness or disability
• To help people get back to work

All measures intended to achieve these goals are referred to as rehabilitation services.

When undergoing rehab, patients are generally treated in special rehab facilities or clinics for three weeks. The rehab deals with both the symptoms and the consequences of an illness as well as (if necessary) the side effects of any treatment.

Rehab involves the use of a variety of measures from different areas. For example, medication-based treatment can be combined with physiotherapy and psychotherapy. The individual components are specially tailored to the patient’s illness and needs.

What forms of rehab are there?

There are various types of medical rehab:

• Follow-up rehab, also known as aftercare rehab: when medical rehab immediately follows a hospital stay
• Indication-specific rehab: rehab tailored to a specific illness, for example cancer, addictions or musculoskeletal disorders
• Geriatric rehab: if a patient’s overall health is affected by several illnesses in old age
• Target-group-specific rehab: rehab for specific groups, for example children, adolescents, parents or family caregivers

Furthermore, medical rehabilitation can take place on an outpatient or inpatient basis: with inpatient rehab, patients are accommodated and cared for in a rehab facility. With outpatient rehab, patients attend a nearby rehab facility during the day but spend the night at home.

One special kind of outpatient rehab is mobile rehab, where an interdisciplinary team will visit the patient at home or in a nursing home. Mobile rehab is intended for people who need constant support or whose living environment has been specially adapted to their disability, for example.

Anyone so severely restricted by health problems or a disability that they are unable to perform their usual everyday activities can apply for rehab. The first step in doing this is to obtain medical advice. The doctor will assess if rehab is medically necessary.

For the responsible bodies to approve a rehab measure, several criteria must be fulfilled.

• Need for rehabilitation: the person’s independence or performance cannot be restored with individual measures.
• Capacity for rehabilitation: the person is able to cope with the necessary rehab measures.
• Positive rehabilitation prognosis: the medical practitioner believes that the rehab goals are achievable.
• Willingness to cooperate: insurance holders must submit all necessary documents, attend an assessment if necessary and be willing to get actively involved with the rehab measures.

There are also conditions that have been established by cost bearers. These are the various bodies that can cover the costs of rehab. If the costs are to be borne by the German Pension Insurance Organization (Deutsche Rentenversicherung – DRV), for example, the patient must have made pension insurance contributions for a certain amount of time.

People with private health insurance usually require additional coverage for medical rehabilitation. Whether and to what extent rehab is covered by private health insurance depends on the specific policy.

Medical rehab combines various different measures to improve mental and physical health. Specialists from various medical fields work together to achieve this.

Following an initial examination and an admission interview, patients receive a rehab plan tailored to their needs and the rehab goals. The measures differ depending on the illness and health condition. Common services include:

• physiotherapy
• occupational therapy
• psychotherapy
• sports therapy
• training courses and lectures
• speech therapy
• nutritional advice

Anyone who needs medical aids, such as a prosthesis or a wheeled walker, can borrow these at the facility and learn to use them. 

Rehab usually takes three weeks but can be shortened or extended if medically necessary. At the end of the rehab process, a final examination and final interview take place. The doctor will record the changes compared to the situation prior to rehab in a final report. If necessary, patients will be provided with information on aftercare measures.

By the end of their rehab at the latest, it is time for many employees to think about returning to work. Anyone who has been unable to work for at least six weeks in the last twelve months is entitled to support from their employer on returning to a company. This is known as company integration management. Gradual reintegration, where you gradually increase the number of hours you work each day, is also a possibility. In the meantime, you will receive sickness benefit or a transitional allowance.

Rehab services have to be applied for. In the case of aftercare rehab, the hospital will determine in advance whether this is necessary and its social service team will help you make the application.

In all other cases, you should start by obtaining medical advice. Your doctor will discuss the rehab possibilities and goals with you, prepare a medical report and justify why rehab is medically necessary. These findings are part of the application. To increase the likelihood of an application’s success, it helps if the doctor provides as much detail as possible about the need for rehab, the rehab goals and the rehab prognosis.

Who will potentially cover the costs of rehab?

Depending on the reason for the medical rehab and its goals, various different bodies are responsible for covering the costs, for example the pension insurance organization or a health insurance provider. These are referred to as “cost bearers”. An application for rehab must be submitted to these bodies.

• Health insurance providers cover the costs of medical rehab if the consequences of an illness cannot be dealt with through medical treatment alone.
• If the aim is to enable someone to return to work, the German Pension Insurance Organization is responsible for the costs.
• In the event of an occupational accident, the statutory accident insurance provider will usually cover the costs.

You can determine who is responsible for the costs in your case by using the rehab responsibility navigator provided by the Federal Association for Rehabilitation (Bundesarbeitsgemeinschaft Rehabilitation – BAR). 

When submitting an application to a health insurance provider, the medical practice will use a standardized template. If you wish to submit an application to the German Pension Insurance Organization, you can contact it to request the necessary documents or use an online form.

Full information and documents in relation to online applications can be found on the German Pension Insurance Organization’s website.

Can I choose the rehab clinic?

Patients have the right to designate a preferred clinic. In their application, they can therefore also state if they would like to be treated in a certain facility or region. Cost bearers must consider patient requests where possible. However, the facilities must be suited to the diagnosis and the rehab goals. It is sometimes not possible for patients to receive rehab at their preferred clinics because the cost bearer has only entered into supply contracts with certain facilities.

How long does it take to receive a decision?

The cost bearer should review the application within a maximum of two months and take a decision on it. If the cost bearer cannot comply with this deadline, it must provide notification of the reasons for this in writing prior to the deadline. If the cost bearer does not do this or the reasons provided are insufficient, the application will be deemed to have been approved. In this situation, you should seek legal advice.

The cost bearer will usually communicate its ruling in a written decision. However, it can also do this verbally over the telephone. In such cases, it is advisable to directly request a written decision. If the rehab is approved, the decision will contain information about the rehab location, start date and duration. It is generally only possible to reapply for rehab at least four years after the completion of rehab. Earlier application is possible on exceptions.

In some cases, the health insurance provider or pension insurance organization may reject a rehab application even though the attending doctor considered the measure to be medically necessary. If a rehab application is rejected, you have one month to submit an appeal.

The appeal should generally be made in writing and be clearly justified. It is usually easier to present your own arguments if you know the reasons for the rejection. If a notification provides no or only very general reasons for rejection, you are entitled to request more detailed explanations and to view the file.

The appeal should be sent as a registered letter so that you have subsequent proof of it. You can also make an appointment with the insurance provider’s office and dictate and sign the appeal there in person. It can also be useful to obtain medical support for the appeal, for example in the form of a short medical certificate.

Patients also do not have to accept if their preferred rehab clinic is rejected and another is named. The justification for the appeal should explain why the preferred clinic is medically suitable and the best choice for the diagnosis.

If the start date is not suitable, an alternative date can often be agreed with the cost bearer and the rehab clinic without an appeal being required.

The costs of medical care, accommodation and meals will be borne by the cost bearers in the case of inpatient stays. Travel costs are also covered. However, the most cost-effective means of getting to and from the facility must be used. On exceptions, the cost of patients using their own car can be reimbursed.

Insurance holders have to make an additional payment to some cost bearers. In the case of health insurance providers and the pension insurance organization, this is capped at 10 euros per calendar day.

Children and adolescents under the age of 18 are exempt from the additional payment. In the case of follow-on rehab, an additional payment only has to be made for a maximum of 28 days (including the length of the hospital stay). If the pension insurance organization covers the cost of the rehab, the additional payment is only due if the employer is still paying the person’s salary. If the cost bearer is an accident insurance provider, the additional payment is generally waived.

How can I obtain financial support during rehab?

If you are an employee, your employer will continue to pay your salary for up to six weeks, as in the case of illness. If this entitlement has been exhausted, the cost bearer will pay sickness benefit, injury benefit (in the event of an occupational accident) or transitional benefit (if the pension insurance organization is paying for the rehab). People who receive unemployment benefits can also receive sickness benefit or transition benefit under certain circumstances.

The German Pension Insurance Organization has provided information on its website about what you should consider if you want to receive transition benefit during rehab.

You can obtain assistance with applications and the formulation of appeals from the Independent Patient Advice Service for Germany (Unabhängige Patientenberatung Deutschland – UPD) or the consumer advice centers.

Social associations also offer their members advice on rehab. The internet addresses of the social associations can be found in the REHADAT database provided by the German Economic Institute in Cologne (Institut der deutschen Wirtschaft Köln e.V.).

Advice can also be obtained from the Supplementary Independent Participation Advice Center (Ergänzende unabhängige Teilhabeberatung – EUTB).

If you are looking for a rehab clinic, you can use the cost-bearer-independent rehab facility directory provided by the Federal Association for Rehabilitation (Bundesarbeitsgemeinschaft Rehabilitation – BAR).

Member institutions of the National Association of Medical-Occupational Rehabilitation Facilities (Bundesarbeitsgemeinschaft der medizinisch-beruflichen Rehabilitationseinrichtungen) can be found on a map on the organization’s website.

Information on how you can be exempted from additional payments if the pension insurance organization pays for rehab can be found on the German Pension Insurance Organization’s website.