Patient transports without authorization: What the latest ruling of the Federal Social Court means for taxi companies

The decision is clear—and it brings movement into a previously clearly formalized process. Although the court emphasizes that prior approval generally remains necessary, it makes one central exception: If all medical and legal requirements for cost coverage are met, the health insurance company may not refuse it solely on the grounds of missing approval. This means: Form should not take precedence over content.

The rationale states literally:

“The health insurance company may not use the absence of approval against the insured if all other entitlement requirements are met and if it does not provide the necessary medical transportation as its own service within the benefits-in-kind system.”

The judges argue that the purpose of the approval requirement is primarily to protect the insured. The approval is intended to provide security – those who have it need not worry about reimbursement. However, if someone drives without approval and it is subsequently found that the conditions for coverage were nevertheless met, then the absence of approval should not lead to exclusion.

"The purpose of the approval requirement in these cases is reduced to providing the insured with legal certainty […]. […] However, this protective purpose would be completely reversed if the lack of approval could subsequently be held against them, even when all other performance requirements are met."

For taxi and rental car companies, the ruling does not represent a fundamental reversal – but it does provide relief in cases of doubt. This is because, especially in the case of regular trips for dialysis, chemotherapy, or radiation therapy, it can happen that an approval temporarily expires or is delayed in being issued. Until now, the rule was: no approval, no reimbursement. But now there is a new scope for discretion – provided all other conditions are met.