Privately insured

Your health insurance (and supplementary benefits, if applicable) usually covers the costs of outpatient psychotherapy in a practice to the extent and amount agreed upon in your contract. The remuneration is based on the Fee Schedule for Psychotherapists (GOP).

I advise you, for your own peace of mind, to inquire more precisely with your health insurance before you start therapy. Usually, a brief call to your health insurance company is sufficient.

The following questions may provide guidance that could be useful during this call:

  1. Does the scope of services include outpatient psychotherapy? How many therapy sessions am I entitled to annually?
  2. Are the costs fully covered by the health insurance, or are there partial costs for me?
  3. Which documents are required for the approval of the therapy, e.g., an application from my psychotherapist or special forms?

The Cost Reimbursement Procedure in a Practice

Due to high demand in society and a simultaneous undersupply of therapists with health insurance panel seats, statutory health insurance policyholders often have to wait for months for a therapy slot.

The assumption of treatment costs in a practice by your statutory health insurance is possible in exceptional cases through the “Emergency Regulation for Undersupply” (§13 Para. 3 SGB V) . The emergency regulation states that in the event of an unreasonable waiting period, your health insurance company must reimburse the treatment by a non-panel therapist. This right to cost reimbursement is legally regulated and applies to all statutory health insurance companies.

After many years of experience with the cost reimbursement procedure, I offer this service in my practice, provided you are willing to cover the treatment costs yourself in case of doubt. The duration of the application process, especially in case of an appeal, varies greatly. To maintain the economic and scheduling stability of my practice, I can unfortunately only offer to assist you with the application and secure a spot for you if you are prepared to bear the costs yourself in case of doubt.

Below you will find an exemplary overview of the cost reimbursement procedure.

  1. Call your health insurance company
    Contact your health insurance company to find out how you can best successfully apply for out-of-contract cost reimbursement for psychotherapy.
  2. Prove long waiting times
    Contact several – at least five, some health insurance companies require ten – panel therapists. Note down the name, date, time, and outcome of the phone call (e.g., Therapist Mustermann, Mustermannstr. 1, Wuppertal, 1.1.2014, 1:45 PM, waiting time 8 months until therapy starts/therapist did not call back). Ask when the therapy would actually begin, not just when an initial consultation would take place. An initial consultation usually only leads to being placed on a waiting list.
  3. Schedule an appointment for a psychotherapeutic consultation hour
    Unfortunately, I cannot offer this service, as it is reserved for panel therapists. You can schedule appointments for this yourself or through the Appointment Service Center of the Association of Statutory Health Insurance Physicians (Terminservicestelle).
  4. Consultation Report
    Schedule an appointment with your doctor (e.g., general practitioner, psychiatrist, neurologist). In a so-called “consultation report,” the doctor certifies that there are no medical contraindications to psychotherapy. This also provides us as psychotherapists with medical information that we can consider and incorporate into our collaborative work.