Caught between two bureaucracies that cannot or will not acknowledge each others’ existence

FIRST VERSION 11 JULY, UPDATED FOR CLARITY 12 JULY – A GERMAN VERSION IS IN PREPARATION

This is largely for my own records, but also to have something to refer to if people ask what on earth happened, when, upon arrival at Admissions at Vivantes Klinikum am Urban at 7 am on 11 July, for pre-surgery tests and examinations, with surgery scheduled the following day, I was asked to pay the bill before anything else could be set in motion.

After final diagnosis on 16 June, and as soon as I had seen the surgeon at Vivantes and we had agreed on the double mastectomy, I was informed by my sickness insurance that I must apply for direct billing, and to that end, I would need to submit a cost estimate. I immediately asked the hospital for this estimate. To actually receive it from them took more than a week, and many e-mails.

When I finally received the cost estimate, I submitted it and applied for direct billing on the same day. It took several e-mails to several different people to make sure that somebody was actually there to see what was pinging in at the JSIS/RCAM, or whatever it is called, end. In the process of submitting documents there were several “internal error” messages which one could only hope someone would fix, and when that happened, eventually, what had previously been entered had disappeared, and I had to start over. Several days were wasted that way.

Eventually, I was informed that they had approved the direct billing application and sent the approval directly to the hospital. What they DID NOT tell me, nor the hospital, was that they had no intention of complying with the hospital’s request to pay the entire amount in advance only based on the cost estimate. I can kind of understand that to them, a cost estimate does not constitute an invoice, but they should have told me that things were not working out the way I thought since I naively thought no news was good news. When in fact, as it turned out, that direct billing thing is a curse rather than a cure.

In the approval sent directly to the hospital, accepting direct billing and confirming that they would pay the estimated amount, they give the exact address to which the invoice should be sent. What the hospital DID NOT tell me was that they had no intention of sending an invoice, since they were unable to mail it to an insurance company outside of Germany. Or at least they did not tell me that till the day of the supposed admission (i.e. the day before surgery). I will never live to understand why they would not send the invoice outside of Germany even if they do look at JSIS/RCAM as a Mickey Mouse “insurance company”.

I, and lot of other people at the hospital, including the surgeon, wasted an entire morning, in my case six hours to be precise (which I could have spent with my brother and sister-in-law visiting from Denmark, had I known that it was all for nothing), trying to get this sorted, with me squeezed between sickness insurance staff and hospital administration, armed with laptop and phone. On several occasions, people on the sickness insurance side told me they had already spoken to the hospital and things were being worked out and I was under no circumstance to pay the bill myself; and the hospital saying nobody had called them, and they were unable to set things (in this case formal admission and pre-surgery tests and examinations) in motion before the bill had been paid. It was farcical.

And then it became too late to start doing the tests and examinations and I left with a new appointment (technical admission 27 July and surgery 28 July). However, currently, the situation seems deadlocked and I have no idea whether things will have fallen into place by then.

It is a good thing I have one of the slowest-growing and least aggressive and invasive forms of breast cancer, according to two different medical professionals at the hospital.

When two bureaucracies are so far from each other, why do they have anything to do with each other at all? Why am I forced to pay towards a sickness fund which clearly does not work in the country in which I live? Is Germany no longer member of the EU? What did I miss?

Why did nobody at the hospital emphasise to me that they needed payment in advance. This is mentioned on page two of the cost estimate which I did not think I needed to read extensively but just forward to the sickness insurance as soon as possible.

Why did nobody in the sickness insurance (and I have been in touch with a lot of people there lately) tell me that it would be best if I paid the bill myself, for subsequent reimbursement, and that the direct billing procedure would NOT work in the case of a hospital in Germany?

And finally, and I don’t mean to whine, but the last month or so has been stressfull to say the least. I now know what people mean when they say a cancer diagnosis and the uncertain future that comes with it causes chaos in one’s head. For me, not least because I had to find another – good – home for my dog (in a city already flooded with dogs for adoption), while (trying to) prepare for major surgery, and whatever treatments may be needed afterwards. It has been hard, and sad, and caused panic and anxiety attacks, “brain fog”, and sleepless nights. There must be so many people in similar situations. I think people deserve things to be running a bit more smoothly than this.