# Coverage for Acne Inversa: How to Submit an Application to Your Health Insurance

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Language: en
Category: Doctor Visits
Published: 2026-05-31
Last updated: 2026-05-31
Author: Dr. rer. nat. Dennis Alexander Kwiatkowski (Biochemist, Scientific Writer and Pharma Expert)
Tags: Acne Inversa, Hidradenitis Suppurativa, HS, Doctor Visits, Acne inversa, Hidradenitis suppurativa, Health insurance, Statutory health insurance, Coverage, Biologics, Rehabilitation

> Biologic, surgery, wound care, rehabilitation and degree of disability: This guide explains how applications for acne inversa can be prepared in Germany.

Medical disclaimer: This website is for general educational information only and does not replace medical advice, diagnosis, or treatment. Please speak with qualified medical professionals about symptoms or treatment decisions.

## Article

> **Note before reading.** This article explains the German application process
> within the statutory health insurance system (GKV) in a general and
> understandable form. It does not replace individual medical, social-law
> or legal advice. Specific decisions are made by your treating physician,
> your health insurer and – in the event of a dispute – by the competent
> social courts or authorities.

Last updated: 31 May 2026.

People living with acne inversa (medically: hidradenitis suppurativa)
often face two hurdles. The first is the disease itself. The second
begins when applications, deadlines, expert opinions or rejections come into play.

This article shows how the application process works in principle, which
documents are helpful and what you can do if a health insurer says no.
The focus is on four common pathways: biologics, surgery and
wound care, rehabilitation and the degree of disability.

## The key points at a glance

- For adults with moderate to severe acne inversa, several biologics are approved in
  Germany, including adalimumab, secukinumab and bimekizumab.
- For many benefit applications, the health insurer must decide within three weeks,
  or within five weeks if it consults the Medical Service and informs you
  of this.
- You can generally file an appeal against a rejection within one month.
- Well-prepared documents often determine the speed and success: the
  medical justification, the severity, prior treatments, findings,
  surgical reports and clear documentation of your burden.
- Independent patient counselling, social welfare associations and experienced acne inversa
  centres can take some of the pressure off with difficult applications.

## Why acne inversa requires applications at all

You receive many statutory health insurance benefits without a separate
application: you go to the dermatologist, receive a prescription and fill it
at the pharmacy. For expensive, special or longer-term benefits, however, the
health insurer often checks in advance whether the requirements are met.

With acne inversa, this can primarily concern these areas:

- **Biologics**, that is, modern anti-inflammatory medications
- certain **dressing and wound products** in larger quantities
- **home nursing care** for wound care
- **medical rehabilitation**
- the **degree of disability (GdB)** and the severe disability ID card, although this
  application is not submitted to the health insurer but to the competent pension office or the
  respective state authority

Behind this, in the statutory health insurance system, lies the principle of economic efficiency
(Section 12 SGB V): benefits must be sufficient, appropriate and economical. In
practice, this means: the more precisely the medical need is justified and
documented, the less room there is for queries and misunderstandings.

## Pathway 1: Coverage for biologics

### Which medications are approved

For adults with active, moderate to severe acne inversa who have not responded
adequately to conventional systemic therapy, the following biologics, among others, are approved in
Germany:

| Active ingredient | Examples | Approved since |
| --- | --- | --- |
| Adalimumab | Humira and biosimilars | 2015 |
| Secukinumab | Cosentyx | 2023 |
| Bimekizumab | Bimzelx | 2024 |

Adalimumab is the biologic that has been approved for acne inversa the longest. With newer
active ingredients, health insurers or the Medical Service may ask more closely whether
the requirements are met and exactly why that particular active ingredient was chosen.

Important to know: this does not automatically mean that a newer biologic is
"worse" or not reimbursable. It only means that the medical
justification should be clear, especially if adalimumab is not chosen or
has already not helped sufficiently.

### How the application works step by step

**Step 1: The medical indication.** Your dermatologist
determines whether biologic therapy is medically indicated. Important factors
are:

- the confirmed diagnosis with the correct diagnostic code **L73.2**
- the severity, for example via IHS4 and the Hurley stage
- an overview of previous treatments and why they were not sufficient
- relevant comorbidities, intolerances or contraindications

**Step 2: Application to the health insurer.** With many insurers the application
consists of a brief cover letter from you and a medical statement. Submit
the documents as completely as possible, because findings submitted later
often cost weeks.

**Step 3: The deadlines.** Under Section 13(3a) SGB V, the health insurer must decide on many
benefit applications within three weeks. If it consults the Medical
Service, the deadline is five weeks. It must inform you of this
in good time.

If the health insurer misses a deadline without appropriate notification, the application may be deemed
approved. The legal consequences are, however, not trivial in detail. When
high costs are involved, you should seek advice before obtaining a benefit
on your own and later requesting reimbursement.

**Practical tip:** Note the date on which the health insurer received your application.
Use an insured-member portal with confirmation of receipt or send
important documents in a verifiable way.

**Step 4: The Medical Service.** The Medical Service produces an
expert opinion. The decision is nevertheless ultimately made by the health insurer. You can request the
opinion as part of file inspection and review it with your physician.

### And if the medication is off-label?

Some therapies are discussed for acne inversa or used in special
situations without being specifically approved for this diagnosis. This is
then referred to as off-label use. Coverage is possible, but requires more
justification.

The application should then set out particularly clearly:

- why this is a serious disease situation
- which approved alternatives were tried or why they are not suitable
- what scientific basis exists for the expected benefit
- why the specific treatment is medically necessary in the individual case

Here, a detailed specialist justification pays off and, in the event of a
rejection, early social-law advice.

## Pathway 2: Surgery and wound care

In advanced acne inversa, surgery, such as deroofing or the
wide excision of the affected tissue, is an important component. Depending on the
situation, such procedures are billed on an outpatient or inpatient basis and often
do not require a separate coverage application from you. The medical
indication is established by the operating practice or clinic.

For everyday life after the operation, care is often decisive:

- **Dressing and wound products** are prescribed by a physician. For certain other
  products for wound treatment, a transitional rule currently applies that
  secures their prescribability at the expense of the statutory health insurance until the end of 2026.
  Ask at your practice which products are currently prescribable.
- **Home nursing care** for wound care can be prescribed if you cannot
  carry out the care yourself or if it is medically particularly
  demanding (Section 37 SGB V). The health insurer reviews this application.

**Practical tip:** Keep surgical reports, wound documentation and photos of
the healing process. They can later be important for follow-up applications, rehabilitation applications and a
GdB application.

## Pathway 3: Medical rehabilitation

Rehabilitation can be useful if acne inversa significantly impairs your ability to work or
your ability to function in everyday life, such as after major
operations, during long periods of sick leave, with persistent pain or under
severe psychological strain.

- If you are employed and covered by pension insurance, the **German
  Pension Insurance** is often responsible. The application runs via form **G0100**;
  medical findings reports supplement the application.
- In other constellations, the **health insurer** may be responsible. The
  process then usually runs via a medical prescription for medical rehabilitation.

Justify specifically how the disease restricts you: pain, restricted
mobility, dressing changes, sick days, sleep problems, ability to work and
psychological strain. The pension insurance mainly examines whether rehabilitation
can preserve or restore your ability to earn a living.

## Pathway 4: Degree of disability and severe disability ID card

Acne inversa can justify a degree of disability. The application does not run via
the health insurer, but via the competent pension office or the respective
state authority.

A severe disability ID card is issued from a GdB of 50. A GdB of
30 or 40 can also be relevant, for example in the case of a possible equal status in
working life. What is decisive is not the diagnosis alone, but the actual
functional burden.

Acne inversa is not always listed in the Medical Care Ordinance under the name
that affected people use in everyday life. Documentation is therefore especially
important:

- a symptom and pain diary over several weeks
- photos of the course
- surgical reports, doctor's letters and findings
- evidence of wound care, dressing needs and sick leave
- certificates of psychological strain or comorbidities
- a description of specific limitations, for example when sitting, walking, raising the
  arms, sleeping, during intimacy or at work

**Practical tip:** If your GdB is set surprisingly low, a
review pays off. An appeal should not just repeat the diagnosis, but
show how much the disease actually restricts your life.

## When the health insurer says no: appeal and litigation

A rejection is not the end of the road.

**1. File an appeal.** You can generally file an appeal against a decision within
one month (Section 84 SGG). At first, a brief sentence is sufficient:

> I hereby file an appeal against your decision of [date]. I will submit a
> justification later.

This way you meet the deadline and gain time for a detailed justification with
your physician or an advisory service.

**Important regarding the deadline:** Since 2025, a decision sent by post is generally deemed
to have been notified on the fourth day after being posted (Section 37 SGB X). So
calculate cautiously. If the legal remedy information is missing or incorrect, a
longer deadline may apply.

**2. Review the expert opinion.** Request the Medical Service's expert opinion
and check it for factual errors. Common points are missing findings, incorrectly
reproduced prior treatments or an underestimated everyday burden.

**3. Litigation before the social court.** If the appeal is also unsuccessful, you can
generally bring an action before the social court within one month (Section 87 SGG). In
particularly urgent cases, such as urgently required surgery, interim
legal protection may be considered.

**4. When nothing happens at all.** For an action for failure to act, different deadlines apply
depending on the stage of the procedure (Section 88 SGG). If no decision is made on an appeal, it
is generally possible after three months. For an application that has not yet been
decided, a deadline of six months often applies under Section 88 SGG; with many
benefit applications under the statutory health insurance, the special rule of three or five weeks
from Section 13(3a) SGB V additionally comes into consideration. Seek
advice if you have questions about deadlines.

## Where you can get help

You do not have to walk this path alone. These bodies can offer support:

- The [Independent Patient Counselling](https://www.patientenberatung.de/) provides
  guidance on patients' rights and insurance questions.
- Social welfare associations such as [VdK](https://www.vdk.de/) and [SoVD](https://www.sovd.de/)
  advise on social law and often also support members in appeal and
  litigation proceedings.
- Specialised acne inversa centres and experienced dermatological practices can
  help to justify applications convincingly from a medical perspective. Our directory
  of [HS specialists](/en/hs-specialists/) offers an initial point of orientation.
- Self-help groups and the exchange among affected people can provide practical tips,
  but do not replace legal or medical advice.

## Your application checklist

Have these documents ready:

- [ ] a current medical statement with diagnostic code **L73.2**
- [ ] severity documentation, such as IHS4 and Hurley stage
- [ ] a list of previous treatments including their effect and
  side effects
- [ ] photo documentation of the affected areas
- [ ] surgical reports, if available
- [ ] a pain and symptom diary
- [ ] certificates of psychological and physical comorbidities
- [ ] evidence of periods of inability to work
- [ ] the date on which your application was received by the health insurer

## What you can take away from this article

With acne inversa, good applications are rarely a mere formality. They translate a
chronic, often invisible burden into documents, deadlines and medical
justifications. The more clearly the diagnosis, severity, prior treatments and
everyday limitations are documented, the better the competent body can
decide.

If an application is rejected, review the justification carefully and do not let
any deadlines pass. A brief appeal is sufficient at first to gain time for a
better justification.

## FAQ

### Do I have to try adalimumab first before I can get a different biologic?

Not necessarily. However, if a different biologic is requested as the first biologic therapy, the health insurer may ask why adalimumab was not chosen. A clear medical justification, such as an intolerance, a contraindication or a particular individual finding, makes the application considerably stronger.

### How long is the health insurer allowed to take?

For many benefit applications, a decision deadline of three weeks applies under Section 13(3a) of the Fifth Social Code (SGB V). If the Medical Service is consulted, it is five weeks, provided the health insurer informs you in good time. The legal consequences of a missed deadline can be complex in individual cases, so you should seek advice before obtaining a benefit on your own.

### Does filing an appeal cost money?

The appeal procedure is generally free of charge. You may incur your own costs if you make use of legal support. Social welfare associations often offer their members support and legal protection in social-law appeal and litigation proceedings.

### Can I get a severe disability ID card for acne inversa?

That is possible. What is decisive is not the diagnosis alone, but the documented functional burden, such as pain, repeated surgeries, restricted mobility, wound care, scarring, psychological strain and comorbidities.

## References

1. S2k guideline on the treatment of hidradenitis suppurativa / acne inversa - AWMF, 2024 - https://register.awmf.org/assets/guidelines/013-012l_S2k_Therapie-Hidradenitis-suppurativa-Acne-inversa_2024-08.pdf
2. Secukinumab for hidradenitis suppurativa, early benefit assessment - Gemeinsamer Bundesausschuss, 2023 - https://www.g-ba.de/bewertungsverfahren/nutzenbewertung/961/
3. Bimekizumab for hidradenitis suppurativa, early benefit assessment - Gemeinsamer Bundesausschuss, 2024 - https://www.g-ba.de/bewertungsverfahren/nutzenbewertung/1087/
4. Section 13 SGB V – Cost reimbursement and decision deadlines - Gesetze im Internet - https://www.gesetze-im-internet.de/sgb_5/__13.html
5. Section 37 SGB X – Notification of an administrative act - Gesetze im Internet - https://www.gesetze-im-internet.de/sgb_10/__37.html
6. Section 84 SGG – Appeal deadline - Gesetze im Internet - https://www.gesetze-im-internet.de/sgg/__84.html
7. Section 88 SGG – Action for failure to act - Gesetze im Internet - https://www.gesetze-im-internet.de/sgg/__88.html
8. Annex to the Medical Care Ordinance - Gesetze im Internet - https://www.gesetze-im-internet.de/versmedv/anlage.html
9. Rehabilitation application G0100 - Deutsche Rentenversicherung - https://www.deutsche-rentenversicherung.de/SharedDocs/Formulare/DE/_pdf/G0100.html