No automatic cost coverage:

I run a private practice, which means I am not contracted with health insurance providers. Therefore, I cannot guarantee that your health insurance will cover the costs of treatment.

​

Application for cost reimbursement:

However, you can submit an application for cost reimbursement to your health insurance provider (§ 13 Abs. 3 SGB V) if you cannot find a psychotherapist who is contracted with health insurance providers. Unfortunately, some health insurance providers categorically reject this process despite your legal entitlement. In this case, I am unable to provide care. However, most health insurance providers reimburse the costs, making it a common and promising approach to start psychotherapy. Studies and experiences indicate that over 90% of applications are approved. With my years of experience in the cost reimbursement process, I am available to assist you with any inquiries during the application process via email or phone.

​

Procedure:

We will schedule an initial consultation. During this consultation, I will explain how to obtain the necessary documents for the cost reimbursement process. If we decide to work together, I will provide you with the required documents.

We will apply for so-called trial sessions (typically 4 sessions, plus one session for biographical anamnesis). The costs for these sessions are usually covered by health insurance without objections. If we decide to proceed with further therapy after these trial sessions, it must be applied for again (but with no effort on your part).

We will apply for further therapy (usually 24 sessions). Health insurance providers typically request a report to be sent to the reviewer. I will then prepare an anonymized report, and a reviewer from the MDK (medical service of health insurance providers) will decide whether to endorse or reject the therapy. In over 90% of cases, therapy is endorsed, but there is no guarantee or assessment of the likelihood of success. If approval and cost coverage are granted, we can proceed with the approved sessions, and the costs will be covered.

​​

Where's the catch?

The application process requires effort. You must:

• Make a phone call to the patient service (116117), which is tasked with referring therapists to you.

• Schedule a consultation with a therapist who is contracted with health insurance providers, who will provide you with the document PTV 11. This document must indicate that you urgently need to start psychotherapy.

• Note down therapists who are currently unable to treat you.

• Visit a doctor who will provide you with a consultation report and, if necessary, an urgency certificate.

• Occasionally, you may need to provide a written explanation to the health insurance provider as to why you need therapy.

None of these steps should take longer than a few hours. It is important to clearly communicate your needs and advocate for them. The process with the health insurance provider can be lengthy and cumbersome, and sometimes you may need to exert considerable effort.

The initial consultation with me must be billed privately because the health insurance provider only covers the costs after approving them (which we can only apply for after the initial consultation). However, I will charge only half of my standard hourly rate for the initial consultation (€50/50min). Following the consultation, I will send you an invoice via email, which must be settled within one week.

Advance payment: You must initially pay the treatment costs yourself. I will send you electronic invoices via email. Afterward, you can forward the invoice to the health insurance provider for reimbursement. Legally, no contract is formed between me and the health insurance provider; rather, you and I are the contracting parties. Unfortunately, this means that I do not have a claim for cost coverage against the health insurance provider. Consequently, they may refuse to cover costs, only cover them partially, or delay payment for several months. Unfortunately, I have no control over whether and to what extent the health insurance provider reimburses your costs. If there are difficulties, you will need to contact the health insurance provider yourself. However, costs are typically fully reimbursed (often within a few days).

​

What if the application is unsuccessful or problems arise?

It is possible that the health insurance provider rejects the cost coverage. In this case, you can submit an informal appeal.  You may consider consulting a lawyer (e.g., specializing in health law) and legally challenging decisions.

You may consider switching health insurance providers. Some health insurance providers have a more favorable process for cost reimbursement than others.