Occupational therapy for privately insured patients

Before treatment begins, we enter into a fee agreement with privately insured patients. This agreement obligates our practice to provide occupational therapy services professionally. In return, the patient agrees to pay the full cost of treatment – regardless of whether and to what extent private health insurance covers the costs.

Whether your insurance will cover the costs of occupational therapy depends on the contractual agreements in your individual plan. It's important that outpatient treatment—especially occupational therapy—is explicitly included in the scope of benefits.

In principle, a refund is only possible if

• a valid medical prescription is available,
• the medical necessity of the treatment is clear from this Regulation, and
• the treatment is carried out by a state-recognized specialist in accordance with the Occupational Therapists Act (ErgThG).

Please review your contract documents in advance, paying particular attention to any limitations on the reimbursement amount or the number of therapy sessions. Reimbursement amounts depend on the plan you have with your insurance company.

For those eligible for benefits, the current federal or state subsidy regulations apply. These vary and may result in partial or no reimbursement. If you have private supplementary insurance, it's also worth submitting the invoice there.

Since the regulations vary greatly from insurance company to insurance company, we unfortunately cannot make a binding statement on the amount of reimbursement.

Our billing is based on the fee agreement and the fee schedule for therapists (GebüTh). Upon completion of therapy, you will receive a detailed invoice, which you can submit to your insurance company.

Are you unsure? Feel free to contact us – we will take the time to answer your questions and support you in clarifying the formal steps.

If services are not reimbursed in whole or in part, even though you expect them to be, it may be advisable to review your insurance company's decision. You have the option of filing an appeal. Whether this is successful in individual cases depends on the contractual terms and the specific reason for the reduction. General information on this can be found, for example, from independent patient advisory services or consumer advice centers.

For further information and support, please visit:

www.privatpreise.de

http://www.mtk-physio.de/Info-Box/Privatpatienten-Info/privatpatienten-info.html

Should any discrepancies arise, you can contact the Private Health Insurance Ombudsman. This office mediates free of charge and impartially between insured persons and insurance companies:

www.pkv-ombudsmann.de