Your health insurance (and, if applicable, Beihilfe) usually covers the costs of outpatient psychotherapy in a private practice to the proportion and extent agreed in your contract. The fees are based on the German Fee Regulations for Psychotherapists (GOP).
For your own protection, I advise you to check with your health insurance company before you start therapy.
Usually a short call to your health insurance company is sufficient. The following questions offer some orientation that could be useful during this call:
- Do my benefits include outpatient psychotherapy? How many therapy hours am I entitled to per year?
- Are the costs completely covered by the health insurance or are there proportional costs for me?
- Which documents are required for the approval of the therapy, e.g. an application from my psychotherapist, or special forms?
Cost reimbursement procedure in a private practice
Due to a high demand in society and a simultaneous undersupply of therapists with a statutory health insurance licence, people with statutory insurance often have to wait months for a therapy to start.
In exceptional cases, the cost of treatment in a private practice can be covered by your statutory health insurance company under the “Emergency regulation in the event of undersupply”
§13 Abs. 3 SGB V) . The emergency regulation states that in case of unreasonable high waiting time, your health insurance company must reimburse the treatment with a therapist not approved by the insurance company. This right to reimbursement is regulated by law and applies to all statutory health insurance companies.
After many years of experience in the cost reimbursement procedure, I offer this in my practice, if in case of doubt you will bear the fees of treatment yourself. The duration of the application, especially in objection, varies greatly. In order to run my practice economically and with a stable schedule, I can unfortunately only offer to accompany the application and assure you of a place if, in case of doubt, you bear the fees yourself.
In the following you will find an exemplary sequence of the cost reimbursement procedure.
- Call your health insurance company
Contact your health insurance company to find out how best to successfully apply for non-contractual reimbursement for psychotherapy.
- Prove long waiting periods
Contact several – at least five, some insurers require ten – therapists with a health insurance licence. Make a note of the name, date, time and result of the telephone call (e.g. therapist Mustermann, Mustermannstr. 1, Wuppertal, 1.1.2014, 13.45h, waiting time 8 months before starting therapy/therapist has not called back). Please ask when the therapy would start and not just an initial consultation. This is because an initial consultation usually only leads to inclusion on a waiting list.
- Make an appointment in a psychotherapeutic consultation.
Unfortunately, I cannot offer this service to you, as it is reserved for therapists with a health insurance licence. You can make appointments for this yourself or via the Appointment Service Office of the Association of Statutory Health Insurance Physicians (Appointment Service Office).(Appointment Service).
- Consiliary report
Make an appointment with your doctor (e.g. family doctor, psychiatrist, neurologist). The doctor certifies that from a medical point of view there is nothing to be said against psychotherapy. We as psychotherapists also receive medical information which we can take into account and incorporate in our joint work.