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

Written by Dr. rer. nat. Dennis Alexander Kwiatkowski

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:

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 provides guidance on patients’ rights and insurance questions.
• Social welfare associations such as VdK and SoVD 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 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.