Reimburcement of cost for members of public health insurance

Normally, every person with public health insurance is entitled to medical and or psychotherapeutic services. In practice, it becomes apparent that appointments, e.g. with ophthalmologists or orthopaedists as well as especially with psychotherapists, can only be maintained with very long waiting times. If these waiting times are unreasonably long, a patient may also obtain the required service privately and demand reimbursement from the statutory health insurance fund.

If you have been trying to find an available spot for psychotherapy for months but have been unable and if the help is urgently needed, you can apply for the reimburcement of cost from your insurance company. The patient then turns to a psychological psychotherapist who can carry out therapy and offers a therapy place promptly but who does not have a public health insurance liscene. However, please note: this must then be exactly the same service that the health insurance company would otherwise pay for. Reimbursement is therefore not a way to alternative medicine! You, the patient, have to pay for treatment but then receive a reimbursement of cost from your health insurance. However, this procedure only works after a previous application. In any case, the person who carries out the action must be just as qualified as someone who is registered as a health insurance company.

Historically, cost reimbursement used to commonly be the only way for patients to receive proper treatment through a psychologist.

However, new laws have changed the way psychologist can offer treatment in Germany. State-approved psychological psychotherapists are able to offer their services and have the cost covered by insurance directly.

This was achieved through an ongoing conflict with medical psychotherapists, whose services were already covered by health insurance at earlier times. The Psychotherapist Act was finally passed in 1999, yet, the statutory provision act (§13 SGV V), which is the legal basis for reimbursement of costs, has remained in force. For a long time, this legal basis was no longer used by health insurance companies because it was simply claimed that there were enough licensed, state-approved psychotherapists and that the waiting times were reasonable. Because more and more people suffer from stress-related problems in recent years and at the same time more and more people see psychotherapy as a way to overcome emotional or psychosomatic problems, the demand for psychotherapy has increased more and more and the waiting times to receive treatment have become extremely long. In some parts of Germany it is almost impossible to find an available therapist. Based on the patients' complaints, health insurance companies then began approving reimbursement of costs.

In the field of psychotherapy, this means that potential patients can also turn to those psychological psychotherapists who have a licence to practise psychotherapy but are not licensed to receive cost coverage through public health insurance. In any case, colleagues must be established in a practice (i.e. not a living room practice). If you see the entry "Kassenzulassung" in our address list of a colleague, then you only need to bring your insurance card. If this note is not there, it may well be that you are offered an appointment and a therapy place, but you should inquire in the first telephone contact how high the costs for the inital conversation will be.

At present (April 2017), health insurance companies expect patients to call several licensed therapists (usually 3-5 colleagues) and obtain information on how long the current waiting times are. If you then explain to the insurance company in a letter that the waiting period is more than three months, the insurance company will process the enclosed application of the therapist. You must also provide a medical certificate (e.g. from your family doctor) stating the urgent need for treatment. Expect that this will not be approved so easily, but that you will have to file an objection.

Reimbursement of costs is a right of every legally insured person anchored in the Social Security Code, but the granting of this right is strongly politically influenced. The political attitude of the board of directors of a health insurance company changes from time to time and with it the instructions given to the responsible clerks. The respective clerks also have their own discretionary powers. Stubbornness and perseverance are required here, because the way over the social courts is very long and very time-consuming.