Objection generator: New online tool helps with problems with care classification

Inge Mauk, 82, lives with her husband in an apartment and suffers from mild dementia. Her application for a care level was initially rejected. The reason given was that she was "too independent." Her daughter subsequently filed an appeal, providing detailed explanations of her mother's actual limitations in everyday life, and submitted a medical certificate. After a further assessment, Inge Mauk was granted care level 2 – retroactively to the original application.

According to the Federal Statistical Office, more than 5.7 million people in Germany receive long-term care insurance benefits, nearly 94 percent of whom receive social long-term care insurance through statutory health insurance funds. The level of care required, which is determined by the Medical Service, determines which benefits and assistance insured persons receive and how much they receive.

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However, it's not uncommon for those in need of care or their relatives to be shocked when they receive the decision from the nursing care insurance fund—and, for example, receive only care level 1, or even no care level at all, instead of the hoped-for care level 2 or 3. Now, a free appeal generator helps them easily file an appeal with the nursing care insurance fund.

The anger over allegedly incorrect assessments by the medical service is a recurring cause for controversy. After all, the issue concerns concrete financial benefits, as part of the care costs are covered by statutory long-term care insurance.

For example, if family members care for someone in need of care at home, the care allowance paid varies by several hundred euros depending on the care level. While insured persons in care level 2 receive approximately 347 euros per month, those in care level 3 receive 599 euros, those in care level 4 receive 800 euros, and those in care level 5 receive even 990 euros.

"When someone becomes in need of care, it is often an enormous emotional burden for the person themselves, as well as for their family members. But in addition to the decision about who will provide care, there is also always the question of how the care will be paid for," says Felizitas Bellendorf, care expert at the North Rhine-Westphalia Consumer Advice Center.

The consumer advice center's care level calculator can help with initial orientation. "This helps determine whether it's even worth submitting an application to the nursing care insurance fund," explains the expert. "If you later disagree with the decision, which is insufficient for the correct assessment, you can file an appeal." The appeal generator can help with this.

Bellendorf sees two key advantages: First, the online tool allows for a quick assessment. Second, the generator immediately creates a complete objection letter with the appropriate justification.

The functionality of the online tool is simple: You enter your own assessment into the tool, along with the corresponding findings from the report. This allows you to work through the report step by step.

If the online tool ultimately calculates a higher care level than the nursing care insurance fund, it will request a justification for its own differing assessments. Based on the justifications, it will automatically create a letter of objection.

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The letter must be printed out and sent to the nursing care insurance fund. The fund will then review the case again. This is usually followed by a second assessment by the medical service, often based on the current file. The nursing care insurance fund then decides whether the care level should be adjusted or confirmed accordingly.

Bellendorf doubts that the online tool will lead to a new flood of appeals. "Because the service not only helps to review classifications, but also to better understand them, thus avoiding unnecessary procedures." He added that there has already been numerous responses from those affected who, while using the appeal generator, reached the same conclusion as the Medical Service, can now better understand the decision.

But how do these different assessments of care needs come about? "There can be various reasons for this," says Bellendorf. "It's not uncommon for those affected to make a special effort to present themselves from their best side during the assessment. They often also claim to be able to handle situations they haven't been able to handle for a long time." This can lead to an incorrect assessment.

On the other hand, relatives would often assess the independence of the person in need of care more pessimistically than the medical service.

"The objection generator is based on the guidelines of the Medical Service. The assessment is not a black box; the online tool helps make the process more transparent. And, in case of doubt, it saves those affected from the unnecessary stress associated with every objection."

The free objection generator can be accessed via the consumer advice center's care level calculator and is available online to anyone interested.