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Doctors offer treatments that health insurers do not reimburse. Their benefits are often controversial. Read here which rules apply.
Berlin. At ophthalmologists, patients are sometimes asked at the reception desk whether they would like to have their intraocular prere measured – at their own expense. It makes sense for the early detection of glaucoma, they say. Such situations are normal in many practices. People are offered services that the statutory health insurers do not pay for. The Extras range from additional tests during pregnancy to examinations for early detection of cancer and professional dental cleaning.
Germans spend about one billion euros a year on such individual health services – IGeL for short – according to estimates by the Scientific Institute of the General Local Health Insurance Funds. But their benefit is controversial. So what should I do if my doctor offers me IGeL??
Self-pay services: Less is sometimes more
Additional preventive medical checkups are particularly popular. But early detection can also be harmful. The frequently offered ultrasound for the early detection of glaucoma is not covered by IGeL Ovarian cancer According to studies, for example, three out of 100 women have healthy ovaries removed. At the same time, it does not reduce the number of deaths from ovarian cancer, comparative studies show. Medical societies advise against the examination without concrete suspicion of cancer, yet gynecological practices continue to offer it.
This illustrates a ProblemEvery doctor can decide for himself which services he offers. Many IGeL are not paid for by the statutory health insurance funds because the benefit of the examination or treatment has not (yet) been sufficiently scientifically proven.
Insured should take their time to inform themselves
Precisely because it is difficult for laypersons to assess the sense or nonsense of an examination, patients should not rush into it. IGeL are almost never urgent. If a concrete suspicion of illness exists, then medically necessary tests are a health insurance benefit.
If you are thinking about a self-pay service, it is best to ask your doctor or health care professional for a benefit and Risks explain. Is there evidence that the test is effective? Why health insurance does not pay for them? Insured persons should take time to think about it. Inform yourself with further sources.
The IGeL Monitor, for example, is helpful. Self-pay services from. Assesses their benefits. Of 55 IGeL examined, only two currently receive a positive rating: acupuncture for migraine prophylaxis and light therapy for seasonal depressive disorder. 29 on the other hand tend to be negative or.
Further Information Patients can also find more information at the Independent Patient Counseling Service, the "Igel-arger" portal of the consumer advice centers and on the patienten-information website.de by the German Medical Association and the National Association of Statutory Health Insurance Physicians.
Maybe the health insurance will pay after all
Some useful offers like Travel vaccinations or sports medical examinations do not belong to the health insurance benefits, because they rather fall under leisure activities. Many health insurers reimburse such tests anyway, as voluntary additional services. In addition to vaccinations, this also applies to some tests for the early detection of cancer. For professional dental cleaning.
It is therefore advisable to first check with your own health insurance before paying anything yourself. If an insured person makes frequent use of certain extras, it may be worth switching to a health insurance fund with suitable Additional services are worthwhile. The money guide Finanztip compares health insurance companies every year and recommends providers with a particularly good ratio of premium amount and extras offered.
Treatment contract and invoice are obligatory
Medical professionals are required to inform patients before performing an examination that is not covered by health insurance. They also have to inform us about the expected costs. Insured persons should ideally have a written estimate of costs demand, so that they know, what comes on them.
Because there are no fixed prices for individual health care services. Doctors calculate such services according to the valid Fee schedule From. The costs depend among other things on the expenditure.
An impression of the usual Price range can win insured on the website of the IGeL monitor. There, in addition to evaluating the benefits of individual services, a cost framework is also given in each case.
Before it goes with a self-payer service, the doctor must have a written Treatment contract conclude with the patient. If this has not happened – i.e. if the patient has not agreed in writing in advance to the chargeable treatment – the doctor cannot bill for the service.
Patients are also eligible for one of the Scale of fees for doctors (GOa) corresponding invoice. This must list all services rendered, the date of treatment, the fee codes according to GOa and the respective increase rate, as well as the costs of each individual service and the total invoice amount.
Only those who have received a correct bill must pay for individual health services. Insured persons should not agree to prepayment. After the treatment they are allowed to Invoice check in peace. There is no obligation to pay still in the doctor's office.
This article is published in cooperation with finanztip.de. The money councellor for consumers is part of the Finanztip foundation.