Therapy Costs &
German Public Health Insurance
Are you under public health insurance and looking for psychotherapy? It can be hard to find a therapist that is covered by public health insurance. But there is a way to get your costs reimbursed, so worry not. The solution we are talking about is called the “out-of-network reimbursement”. It allows you to see a therapist with a private practice and get it covered by your public health insurance.
It’s fairly easy: Basically, you submit an application to your health insurance and if they respond positively, you can begin your therapy fully or partially covered.
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Why do we need the out-of-network reimbursement in the first place?
In a nutshell: If you are under public health insurance, your goal is to walk into the practice and be billed via your legal chip card. It is however hard to find Psychotherapists who can give this service because of a limited supply of allowances per area. This allowance is known as “Kassensitz” in Germany.
When you see a therapist in a private practice like mine, you either pay the bills out of your own pocket or you use the out-of network reimbursement (“Kostenerstattung”). Approved therapists in a private practice have completed the same training as therapists “mit Kassensitz'' and therefore offer the same therapy. The only difference is the way of billing.
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Out-of-network reimbursement / cost reimbursement = “Kostenerstattung”
Eligible for public health insurance (Gesetzliche Krankenkasse)
Getting the out-of-network reimbursement approved by your health insurance is not very complicated. The application process does however require your initiative as well as patience and perseverance.
Online therapy covered by health insurance
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Good news: online therapy can also be covered under this type of reimbursement. The probatory sessions must however take place in person at my practice in Berlin.
After that, we can continue online. This is perfect for people with busy schedules, or people who travel often. It allows you to conveniently schedule psychotherapy from wherever you are.
Therapy for Digital Nomads? No problem!
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Applying for Cost Reimbursement
01.
Calling your insurance company: What documents are required?
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Tip: Let them know that psychotherapists with health insurance coverage had no availability
02.
Rejection list
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Collect approx. 10 - 20 refusals from psychotherapists
03.
Initial Psychotherapeutic consultation
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PTV-11 form: diagnosis and indicating behavioural therapy & urgency.
04.
Appointment service
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Ask for probatory sessions and document any refusal
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06.
Initial consultation and probatory sessions
Getting to know each other in my practice in Berlin
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07.
Konsiliarbericht
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This you get from your GP
08.
Send all collected documents to the health insurance company
How To: Step by Step
Your request to me
Do you have your eight to ten rejections, as well as the diagnosis and PTV-11 in hand? Have you already spoken to your health insurance company? Then you can now book an appointment for a short, free meeting with me . During the conversation, we will see whether we can imagine working together.
FAQ Reimbursement process for Public Health insurance
Who will contact my health insurance company?
The reimbursement must be applied for by you (and not by the respective therapists). The application process therefore requires your initiative. However, we can go through it together and talk about these details in our first trial sessions. Therapists also have to submit a few documents to the health insurance as well, for instance to prove their qualification.
My health insurance company has refused to cover the costs – what now?
Please ask for an explanation from the person in charge at your health insurance company. Tip: Ask for the detailed legal grounds that are being used as a basis for their decision making. Remind them of the fact that there are not enough therapists under public health insurance (“Systemversagen”). Rejections at the first attempt are common. However, there is a good chance of getting the reimbursement approved after further communication.
I don't live in Berlin. Can we still work together?
Yes. But the application for out-of-network reimbursement requires that the probationary sessions must take place in my practice in Berlin for at least 2 sessions. All future sessions after the application can be done online.
Reimbursement and therapy in English – is that possible?
Yes. Many of my clients are internationals and we communicate in English. However, for the out-of-network reimbursement you must be covered by a German public health insurance.
Can sex therapy be reimbursed?
In principle, behavioural therapy can be helpful for a sexual disorder. It depends on each individual case and to what extent the disorder requires treatment.
Certain "sexual dysfunctions" such as erectile dysfunction, failure to lubricate in women, orgasm that occur "too late" or "too early", pain during sex such as vaginismus or dyspareunia as well as "disorders of sexual preference" such as fetishism can be a reason for therapy.
In addition, there are also links between other mental illnesses and sexuality that can be illuminated in psychotherapy. Depression or anxiety disorder, for example, might also involve sexual difficulties. Sexual challenges can be very emotionally draining and contribute to other mental health disorders. We can clarify all of this in more detail during our probational sessions.
Can couples therapy be covered by public health insurance?
Unfortunately not. Couples therapy is not covered by public health insurance and must be paid for by the patient.