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.
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.
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
Good news: online therapy can also be covered under this type of reimbursement. The first four probationary 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!
Out-of-network reimbursement for public health insurance in Germany
The application for the out-of-network reimbursement is similar for all public health insurances. Before you send your application to your insurance, we will meet for our trial sessions where we will get to know each other (up to 5 sessions). These trial sessions are also sometimes referred to as probationary sessions. In this time we will also clarify any personal as well as practical questions relevant to the therapy.
In order for your application to be approved, it is important that we do the probationary sessions in my practice in Berlin. All other future sessions can then take place online if that is more convenient for you.
How to get quick and easy reimbursement
First step: Contacting the health insurance company
The first step is always the most important: It is best to call your health insurance company first and inform them that you have tried to find a therapist covered by health insurance. Tell your insurance that you need therapy urgently and that you tried your best to find a therapist with “Kassensitz”. Ask your insurance about the out-of-network reimbursement (“Kostenerstattung”) as well as the documents they require when applying for the reimbursement. Your health insurance might cover the costs of the probationary treatment as well, so remember to enquire about this, too.
Step two: Documentation of the contacted psychotherapists
Your public health insurance will ask you for proof of your efforts to start therapy under regular public health insurance. You will have to contact eight to ten psychotherapists who are covered by the insurance company. Write down their name, address, the date of request and the reply to your request (most often the result will be: no appointments available). Some health insurance companies offer this list as a template. You can usually find psychotherapists with a registered office in your state by using the search function of the Association of Public Health Care (“Kassenärztliche Vereinigung”) in your state. If you live in Berlin, you can find one at the KV Berlin.
Third step: Psychotherapeutic consultation ("Sprechstunde"), diagnosis and PTV-11 form
While you are making the list of refusals you can book the psychotherapeutic consultation with a psychotherapist who is registered with your health insurance company. You can easily book appointments online via the appointment service (Berlin).
Once you’re at your appointment, you will most likely be told that there are unfortunately no current therapy places available. Nevertheless, you will receive your diagnosis and the PTV-11 form. Is important that the PTV-11 form recommends behavioural therapy and notes urgency.
Your request to me: probation therapy sessions (“Probatorik”)
Already have your eight to ten rejections as well as the diagnosis and PTV-11 in hand? Already spoken with your health insurance? Great, now you can make an appointment for your first probational session with me.
We can start directly with our probation sessions but please note: if your health insurance company refuses to cover the costs, you will have to pay for the probationary sessions yourself. If you do not want to take this risk, you can ask your health insurance company to approve the probation in advance and we can book the first appointment after confirmation is received.
During the probationary period we get to know each other. Here you decide whether you want to continue therapy with me and I will write a report about your symptoms as well as the goals of the therapy. This report will then be approved by neutral experts. You can also ask your family doctor for a consultation report during this time as an extra recommendation.
Now all we have to do is send all the collected documents to your health insurance company and wait for approval. After the out-of-network reimbursement has been approved by the health insurance company, we can start the therapy.
Things to do before you contact me
1 Step: Contacting the health insurance company. Which documents are required?
Tip: Tell them right away that you have already contacted a few psychotherapists who are covered by the health insurance but that there were no slots available.
2. Make a list of enquiry attempts to document your efforts:
Collect 8 to 10 refusals from psychotherapists that could theoretically bill you via health insurance to support your above claim.
3. Go to initial Psychotherapeutic consultation "Sprechstunde":
Receive a PTV-11 form which contains a diagnosis and notation indicating behavioural therapy & urgency.
Then: Contact me for an appointment.
4. Probatory Sessions ("Probatorik")
Getting to know each other in my practice in Berlin
5. Consultant report ("Konsiliarbericht")
This you get from your GP
6. All documents will be send to your inurance
Now: Start therapy!
In my practice in Berlin or online
FAQ Reimbursement for Public Health Insurance
Who contacts my health insurance?
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 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 do not 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.
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 covered by public health insurance?
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.
Is couples therapy covered by public health insurance?
Unfortunately, no. Couples therapy is not covered by public health insurance. Normally, you must pay for couples therapy by yourself.