It can be complicated
Paying for medical bills, regarding health insurance Germany, has changed slightly in recent years. While it is also very different for people covered by the government’s public health insurance, which is often called the statutory system, compared to those covered by private health insurance.
Governmental public health insurance system (Gesetzliche Krankenkasse)
People covered via the statutory system, when visiting a doctor or obtaining a prescription, can expect to contribute small co-payments. This can be applicable when visiting a hospital too. You should also bring with you your health insurance card when seeing your doctor, or following admittance to hospital. Every quarter your doctor will usually receive a 10 euro co-payment. Though, if you see the doctor twice or more in a quarter you still need to pay only for your first visit. When you are referred by your doctor to another, either for more treatment or an examination, this will typically involve a written referral. The new doctor will not receive the co-payment. However, if you make an appointment with another doctor when you don’t have the written referral, then a co-payment can be expected.
Also expect to pay small co-payments to the pharmacy when you receive your prescription. This can, though, depend on what type of medication you have been given. While the majority of insurers will pay all the money for generic drugs, brand drugs can involve charges. In most cases, insurance companies will not cover drugs that are sold over the counter, and which don’t require a prescription.
When hospitalized, 14 euros could be charged daily, with expenses such as TV rental and telephone being paid for by the patient.
Usually, dentist bills are not covered completely by statutory insurance. Between 20 and 70% could be charged, depending on your insurance, towards dental bills.
Though responsible for co-payments, and also sometimes for part of any dental bills, a patient won’t however have to worry about the rest of their bills, as these are taken care of directly by the health insurance system. In the majority of instances you’ll get sent a copy of your bills.
As things can be complicated, though, you should contact your insurer concerning fees and coverage.
Private Health Insurance (Privat Krankenversicherung)
A card featuring a smart chip is issued by the majority of private insurers. When a patient is hospitalized the bill may typically be sent directly to a private insurer for them to pay. A copy of the bill will be sent to you, and you could have to pay for the likes of TV rental or telephone.
Outpatient services may require paying for the bill first if you’re privately insured. But, you can be reimbursed following a submission to a private insurer (this is typical when it comes to prescriptions). Alternately, you could have your insurance company make a direct payment.
It is normal for an original and duplicate of bills to be sent by doctors, dentists and health care providers. Pharmacies will also usually ask if you want a duplicate copy of your prescription. A duplicate copy is sent, because the original needs to be sent to your insurance company. When no duplicate is sent it’s advisable to make a copy.
Governmental regulations can suggest costs for a wide variety of treatments and procedures. Though, among health care providers, notably dentists, treatment may be offered independently of government regulations. It’s always wise to check what treatments and procedures will be reimbursed by your private insurer.
When submitting a bill it’s advisable to include a cover sheet that includes relevant dates, the name of the provider, and the full amount. Reimbursement can take up to three weeks, and is typically done by bank transfer.
If you are declined a reimbursement you should ask your insurance company as to the reasons why. An ombudsman can help with disputed claims regarding health insurance Germany, but this can be a lengthy process. Other options are an independent insurance broker, or to ask an insurance agent whether you can be reimbursed to some extent at least.