Your rightful claim to psychotherapeutic acute treatment

Your legitimate entitlement to acute psychotherapeutic treatment

Getting a psychotherapy appointment has been almost impossible for those with statutory insurance for years. The therapists approved by the health insurance are limited and mostly maintain long waiting lists.

What many people do not know: the statutory health insurance is obligated to ensure comprehensive, needs-based, and local care for its insured individuals. Furthermore, they must ensure timely necessary treatment for their insured individuals.

This means: if you find a therapy spot with a private practice psychotherapist only after an unreasonably long waiting period despite reasonable search activities following the initial interview recommendation, your statutory health insurance (GKV) is not able to fulfill this legal mandate. In these cases, you have the right to procure the necessary service yourself. The costs incurred by procuring these services yourself must be reimbursed by the GKV. This entitlement is legally regulated in § 13 paragraph 3 of SGB V and applies to all statutory health insurances.

This process is called Reimbursement procedure.

With this, you do not need to fear any disadvantages in terms of treatment quality, as you receive the same treatment methods as with a psychotherapist who has a contract with statutory health insurance and can bill directly.

Requirements for Approval

In general, it applies in this context that the patient must demonstrate in the reimbursement procedure that they have unsuccessfully tried to find a therapy place with a licensed therapist and thus provide "proof of system failure." For this, you should document calls and rejections from a certain number of therapists in writing.

In order for the application to be approved, the patient must have attended a psychotherapy consultation (initial interview) before the start of psychotherapy. The reason for this is that the therapist needs to issue a form (PTV-11) which includes the suspected diagnosis, a preliminary report of findings, and the recommendation on the type of treatment. Additionally, the psychotherapist can indicate what constitutes a reasonable waiting time for a therapy slot, thereby clearly demonstrating the urgency of the psychotherapy.

If you want to make use of the reimbursement process, it is advisable to contact your statutory health insurance company in advance and ask about the "preferred" procedure. This way, you can avoid unpleasant surprises later on and prevent the rejection of the reimbursement application.

Further information and tips from the Chamber of Psychotherapists can be found at this Link  

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