A Fundamentally Different Money Flow
Statutory insurance works on the benefits-in-kind principle: you show your card, the doctor bills the sickness fund, and you never see an invoice. Private insurance inverts this. Under the reimbursement principle (Kostenerstattungsprinzip), the doctor treats you as the contractual partner, sends you an itemised invoice, and your insurer reimburses you according to your tariff.
Why it exists: the direct billing relationship is what buys private patients transparency and priority — the doctor knows exactly what will be paid and by whom. It also means you see, line by line, what your healthcare actually costs.
The Standard Cycle
- 1. Treatment: you identify yourself as a private patient; no card terminal, no co-payment at the desk
- 2. Invoice: arrives by post or email, itemised under the GOÄ fee schedule, usually with weeks to pay
- 3. Submission: photograph and submit via your insurer's app the same day
- 4. Reimbursement: typically lands in your account within days to two weeks
- 5. Payment: you pay the doctor — normally with the reimbursement already received
The Exceptions That Protect Your Cash Flow
Three areas bypass the pay-first pattern:
| Area | How it works |
|---|---|
| Hospital stays | The Card für Privatversicherte / direct billing: clinics settle general hospital services directly with your insurer |
| Expensive medication | Many insurers offer direct settlement with pharmacies for high-cost drugs |
| Large planned treatments | Request a written benefits confirmation (Kostenzusage) beforehand; many providers then accept assignment of the claim |
So the scary scenario — fronting a €30,000 operation — essentially does not occur in practice: inpatient costs are settled between clinic and insurer.
Habits That Make It Effortless
- Submit immediately, pay on the deadline: the reimbursement usually arrives first
- Keep a running folder (or rely on the app's archive) — invoices can matter for deductibles, refunds and taxes
- Mind your deductible and premium refund: for small invoices it may pay to not submit at all in a claim-free year
- Get pre-approval for anything expensive or unusual (dentures, psychotherapy, rehab) so the reimbursement amount is confirmed in writing before treatment
The Bottom Line
The reimbursement principle sounds like extra work but settles into a two-minute routine: photograph, submit, pay when due. In exchange you get the private patient's transparency and status — and with hospital direct billing and pre-approvals, the big sums never need to touch your account at all.
Frequently Asked Questions
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