reimbursement psychotherapy

How to get the Statutory Health Insurance to reimburse you for private Psychotherapy


An english speaking therapist covered by german public health insurance is hard to find. Reimbursement for private psychotherapy might be an option.
Even though Soulmates – Psychological Support is not reimbursable by statutory health insurance, we would like to provide this usefull information to you.
Many thanks to the great colleague and highly appreciated guest author Katrin!
Tina Steckling


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A step-by-step guide

by  Dipl.-Psych. Katrin Terwiel

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General information

In Germany there are different forms of psychotherapists:

  • “Public” practices (“Praxis mit Kassensitz) – the costs are covered by the statutory
    health insurance
  • Private practices – the costs are not covered by the statutory health insurance and have to be paid privately

Due to an increasing demand of people seeking psychotherapeutic support and a stagnating number of  “public” psychotherapists, it can be difficult to find a psychotherapist that is covered by the statutory health insurance. Waiting times of several month are not uncommon, which can be a challenge for people in urgent need for a therapy.

Based on this development a growing number of private psychotherapy practices are opening, which usually can offer capacities and have shorter waiting times than public practices, but have to be paid privately.

But, since psychotherapy is an insured benefit in all statutory health insurance funds, there is a legal claim, that the health insurance has to cover the costs for a psychotherapy – even if it is conducted through a private practice, if the therapist is licensed in a method, which is approved by statutory health insurance. (“approbierter psychologischer Psychotherapeut in einem Richtlinienverfahren”).

Prerequisites to claim the reimbursement are, that the patient can prove that

  • he/she has is in need of a psychotherapy
  • he/she could not find a place at a public practice

Following you will find an instruction that will explain you step-by-step how to find an insurance covered psychotherapist in Germany. It will also explain how to request reimbursement in case you can’t find a therapist that is covered by the statutory health insurance.

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1/4 Step 1: Arrange an appointment for an initial consultation 

First step for finding a psychotherapist is to arrange an appointment for a first psychotherapeutic consultation („Psychotherapeutische Sprechstunde“).

This is done via the “Zentrale Terminvergabestelle der Kassenärztlichen Vereinigung (KV)” (Department of the Association of Statutory Health Insurance that coordinates doctors’ appointments).

The “Zentrale Terminvergabestelle” will allocate you an appointment within four weeks. After this first consultation you will receive a provisional diagnosis, evaluation of the level of urgency and recommendations. This all will be recorded in a document named PTV11.

This form is an important document for the application of reimbursement through the statutory health insurance.

Important

It is important that you opt for one of the three psychotherapeutic methods that are approved by health insurances:

  • Behavioral therapy
  • Psychoanalysis
  • Depth-psychology

It is recommended to get a consultation to determine, which method is the most suitable for your specific condition.

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2/4 Step 2: Contact public psychotherapists
(“Psychotherapiepraxis mit Kassensitz”)

Whilst waiting for your initial consultation, it is advised to make use of the waiting time and already start researching for a psychotherapist that is covered by the statutory health insurance (“Psychotherapeut / Psychotherapeutin mit Kassensitz”).

Important

Make sure to document your research and keep track of:

  • Date and time of contact
  • Result of the approach – could you arrange an appointment or not?
  • Waiting time for the appointment

You will need to provide a list of 5 or more therapists who don’t have any free spots or a waiting list longer than 3 months.

In addition to recommendations by family or friends, you can check the following websites to search for a psychotherapist:

Die kassenärztliche Vereinigung Berlin
“Association of Statutory Health Insurance Physicians Berlin”
Please select “Psychologischer Psychotherapeut/in” or “psychotherapeutischer Arzt/Ärztin” (psychological psychotherapist or psychotherapeutic doctor) as specialisation.
You can also search for a preferred method, such as depth-psychology.

Psychotherapeutenkammer
“Medical association of psychotherapists”
Please select “Kassenleistung” (covered by public healthcare) in the advanced search options.

Psychotherapieinformationsdienst der Deutschen Psychologenakademie “Psychotherapy information service of the German academy of psychologists”
This website will also provide you with contact details of psychotherapists.

Further there are various websites such as Therapie.de.
Please select “Krankenkasse” (statutory health insurance) in the advanced search options.

If you are lucky you will already have found a psychotherapist at that stage of your search!

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3/4 Step 3: Contact private psychotherapists

In case you could not find a public psychotherapist, you should expand your search to psychotherapists that operate privately. Usually they have greater capacities for new patients. You still need to look for a ‘Psychologischer Psychotherapeut’.

If you found a private practice with free capacity make a first appointment to get to know the therapist and to check if you feel comfortable with the him/her. You will have to pay for the first session yourself.

Important:

Please inform the psychotherapist that you have already conducted step 1 – 2 of this document, but could not find a public practice. This allows the therapist to prepare the documents that are needed to request a reimbursement

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Step 4: Request a reimbursement of costs

At this stage you will need to make an appointment with your general practitioner (GP) or a psychiatrist. This appointment serves to issue a “medical certificate of necessity” (“Ärztliche Notwendigkeitsbescheinigung”) and a “consultation report” (“Konsiliarbericht”).

These documents show that there is a need for treatment and that there are no medical objections against that treatment.

Together with the psychotherapist you can now request the reimbursement for the psychotherapy. Your psychotherapist will support you in this with his registration number of the medical register of the KV and a copy of the certificate of approval and procedure for the selected treatment method.

Once all documents are in place, the request can be sent to the health insurance.

Important

In case you don’t want to wait for the approval through the health insurance, you can start with the psychotherapy at any stage of the process, as long as you pay the costs out of your own pocket.

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Step 5 (optional): What to do in case that the reimbursement was rejected?

In case your application gets rejected you might want to lodge an objection (“Widerspruch einlegen”). This can be done directly with the health insurance or with a lawyer.

Often, the threat of legal action is already sufficient to trigger the reimbursement. If you can prove urgency and that no public therapist was found, the coverage of the costs is regulated by the law (§ 13 (3) SGB).

 


Dipl.-Psych. Katrin Terwiel - Psychologische Psychotherapeutin

"As a psychotherapist, Katrin Terwiel is passionate about improving the lives of the people she works with. This applies to her private clients as well as to the employees of the companies and organizations she supports. As an external consultant, she provides executive coaching, hosts workshops about various topics and supports companies to implement structures, processes and measures for a better and healthier working environment.
To connect with Katrin visit www.katrin-terwiel.de "

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*Soulmates – Psychological Support is not reimbursable through the statutory health insurance (Only private pay and some private insurances).
As certified practioners of psychotherapy we are not bound to the requirements of the statutory health insurance and can start right away.