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BSG: So far, there has been no recommendation from the responsible doctor-fund committee
The so-called helmet therapy for the treatment of an unbalanced or deformed head of an infant is not part of the benefits catalog of statutory health insurance. The Federal Social Court in Kassel ruled in several judgments from the previous day (Az .: B 3 KR 17/16 R and others).
During controversial therapy, babies are given a kind of helmet (medical: head orthosis). This only leaves specific space at certain points so that the skull grows primarily there and thus gets a uniform shape. Therapy should begin between the fourth and twelfth month of life at the latest and lasts two to three months for minor deformities and longer for severe deformities. The helmet should be worn 23 hours a day.
In the four cases decided by the BSG, the cost of such therapy was between 1,300 and 2,000 euros. The parents of the children had asked their health insurance companies to do this for them. The coffers refused to do so.
Rightly so, as the BSG decided. A slight asymmetry of the head should not be seen as a disease anyway. However, severe forms "cannot be discussed in advance of every illness value". But there are recognized treatment methods through positioning and physiotherapy. "Helmet therapy", on the other hand, is a "new treatment method" for which a positive assessment by the Federal Joint Committee is still missing.
In this federal committee, doctors, hospitals and health insurance companies jointly decide on the list of benefits offered by statutory health insurance. Consumer and patient representatives are involved, but have no voting rights. Without the recommendation of the Federal Joint Committee, statutory health insurance companies generally do not have to and must not pay for a treatment method.
According to a statement by the Society for Neuropediatrics and the German Society for Social Pediatrics and Adolescent Medicine in 2012, the treatment results for severe deformities with a head orthosis are better than with the recognized therapies. However, there is no evidence that failure to treat a deformed head could have adverse medical consequences later. It is therefore questionable "whether helmet therapy has a medical benefit beyond the purely cosmetic improvement of cranial asymmetry". mwo