How does the cost reimbursement procedure work for individuals with statutory health insurance in Germany?
The cost reimbursement procedure offers patients with statutory health insurance a way to have the costs of psychotherapy in a private practice reimbursed. This opens up the option of starting therapy promptly (i.e., within three months), even when no therapy slot is available with a provider holding a statutory insurance contract (i.e., a practice where costs are covered by statutory health insurance).
Important: This decision rests with the statutory health insurance provider! Written confirmation from the health insurance provider must be obtained before therapy begins; otherwise, you will be billed privately for the costs.
1. Step:
Once you have consulted your health insurance provider regarding any specific requirements, attend a consultation with an outpatient therapist who is accredited by the statutory health insurance system (you can obtain information on this via the 116117 service). If it is not possible to secure a therapy slot there in a timely manner, have the consultation form (PTV 11) filled out. The form must state that: 1. outpatient psychotherapy is necessary, and 2. no therapy slot is available at the practice in the near future.
2. Step:
You must now provide written proof that you have attempted to secure an appointment with a practice covered by statutory health insurance. As a rule of thumb, 5–10 rejections are required; you should document these with the following details:
- name
- date and time
- reason why you can't be provided with psychotherapy
And you can repeat step 1 and collect several PTV 11.
3. Step:
Consult your general practitioner or specialist and obtain a medical consultation report—confirming that your symptoms cannot be fully explained by a physical diagnosis and that there are no physical reasons precluding psychotherapy—as well as a certificate of urgency.
4. Step:
Now, obtain a statement from a practice that does not hold a statutory health insurance contract (Kassensitz), confirming that therapy can be started there promptly. You can contact such a practice at, for example, kontakt@psychotherapie-stebane.de.
5. Step:
Submit at least one PTV 11 form, the call log, the medical consultation report, the certificate of urgency, and the private practice's confirmation of the start of therapy to the health insurance fund.
6. Step:
Wait for approval. The health insurance provider has a processing time of 3–5 weeks from the date the application is submitted.