Sick abroad: Doctor visits and hospital stays
We explain what needs to be considered if treatment is required abroad, which services are covered by health insurance, which treatments have to be approved separately and where pitfalls lurk.
The essentials in brief:
- Whether vacation or professional reasons, good preparation before traveling outside of Germany is recommended.
- More and more people are going abroad to seek medical treatment there.
- Treatment tourism flourishes because savings are used as a lure.
- If you are considering visiting a doctor beyond the borders, you would do well to know the regulations of the health and private insurance companies.
sick on the journey
Statutory health insurance pays for treatment in the event of an acute illness or an accident both in an EU member state and in countries with which there is a social security agreement. The German Liaison Office for Health Insurance Abroad offers a country overview .
At the doctor's or in the clinic, patients must present the European Health Insurance Card (EHIC) and their identity card. The EHIC is located on the back of the electronic health card. On site you then fill out a form that entitles you to treatment abroad. The health insurance company responsible for your stay abroad will then assume the costs for all services to which a person with statutory health insurance is also entitled in the respective holiday country. If the doctor or clinic does not accept the EHIC, the patient pays in advance and later submits the invoices and receipts for reimbursement. As a rule, the health insurance companies only cover the costs that would also be reimbursed by the health insurance companies in the respective country. Those with statutory health insurance must therefore pay deductibles and co-payments,
Anyone who travels to countries outside the European Union with which there is no social security agreement, such as the USA or Thailand, will not be reimbursed by the health insurance company for the treatment costs incurred abroad.
Often vacationers on site - for example by hotel employees - are recommended purely private doctors or clinics. But be careful: As a rule, you may only use doctors and hospitals that are authorized to care for the insured person in the health insurance system of the country in which you are staying . It is best to research who is suitable for this before you travel, since in case of doubt you may not have the time or the internet connection.
Some statutory health insurance companies offer improved protection for trips abroad in the form of optional tariffs. Such tariffs are usually linked to certain binding periods, so that you cannot cancel your statutory health insurance before several years have elapsed.
Private travel health insurance policies, on the other hand, are taken out independently of the statutory health insurance company. They also do not trigger any commitment periods if they have been arranged by the statutory health insurance company. Incidentally, the private travel insurance recommended by your own health insurance company is not necessarily the best. Here, too, the comparison is worthwhile.
For treatment abroad
As a person with statutory health insurance, you can also be treated within the European Union. Anyone who sets out, for example, to have their teeth straightened in a neighboring country because it is cheaper there, should note the following: Certain services - such as dentures or cures - must be paid for by the health insurance company beforehand, as with treatment in Germany be approved. In the case of dentures, a cost estimate, the so-called treatment and cost plan, must be submitted to the insurance company, otherwise they will not assume the costs. The Federal Social Court (Az.: B 1 KR 19/08 R) confirmed this requirement on June 30, 2009 . Planned hospital stays - with the exception of emergencies - must also always be approved by the responsible health insurance company.
Search for the right doctor
In many cases, the health insurance companies can provide information about doctors with whom their policyholders have had positive experiences and offer other helpful information. Doctors and clinics often also present their services on the Internet. In addition, the medical services of the automobile clubs are useful sources of information for obtaining information about German-speaking treatment options abroad.
What needs to be clarified before the treatment
- Before planning treatment abroad, patients should find out as much information as possible about the doctor. In any case, prior to treatment, care must be taken to avoid communication problems with the doctor. If necessary, an interpreter should be called in.
- Particular attention should be paid to the doctor's qualifications and the quality standards of the clinic or practice. For example, an existing certification according to European standards can help with the assessment - such as the ISO mark, which, among other things, refers to regular monitoring of the practice. This also applies to the material used. It can also be helpful for patients to inquire about a so-called material pass before the dentures are made, which provides information about the material used and the laboratory used.
- The date and course of the treatment should be precisely coordinated before the treatment - from the duration of the preliminary examination to the therapy and the aftercare. In the case of surgical interventions, for example, regular aftercare is very important for smooth healing. Follow-up treatment can take several weeks and make your own treatment costs more expensive. Additional travel costs can be avoided by cooperation partners - such as resident dentists - who take over the follow-up treatment in Germany.
- Before the treatment, patients should make sure that they are given a cost estimate that is as accurate as possible. In order to avoid problems with the later invoice, it is also important that the offer from the doctor or clinic includes all necessary measures - such as anesthesia or X-rays.
- German law does not automatically apply. For this it is essential to conclude a private treatment contract with the foreign doctor and/or other service providers.
- In order for the attending doctor to be sufficiently informed and able to plan, it is important that all existing and necessary documents of the patient - such as X-rays and findings - are made available to him in good time.
Frequent treatments abroad
dentures
In principle, every insured person receives a fixed subsidy from their health insurance company for dentures. This
flat rate is the same for all the same dental complaints - such as a
missing molar - and is independent of the actual costs incurred through
the selected form of care, such as a bridge or implant. This rule also applies to treatments abroad. For
patients who would like to have their teeth straightened in a
neighboring country, it is advisable to first have a treatment and cost
plan drawn up by a German dentist. The
calculation contains information about the costs due in Germany,
specifically: the subsidy from the health insurance company and the
personal contribution that the insured have to pay for the chosen care. According
to this, a treatment and cost plan based on the German model must also
be requested from the selected foreign dentist. This must be submitted to your own health insurance company for approval prior to treatment. Before
doing so, however, the costs due abroad - including travel and
accommodation costs - should be compared with the expenses incurred for
the dentures in Germany. If problems arise, the treating dentist in
Germany is always obliged to repair or - if necessary - replace the
dentures to make. This
regulation does not apply to treatment of German insured persons abroad,
so the correction should be agreed in writing with the foreign dentist.
If follow-up treatment is due in Germany,
Cures
Some health insurance companies have contracts with spa facilities in Eastern Europe. Such agreements facilitate direct billing between the responsible health insurance company and the service providers abroad. Patients
who are looking for a suitable stay at a spa should ask their health
insurance company whether a special agreement with service providers
exists or is planned. Patients can choose whether they want to complete a cure in Germany or in other European countries. In any case, the service must be approved by the health insurance company. In
addition to the respective special features of the facilities - such as
therapy offers - the travel costs should always be compared with the
possible savings.
drug
Medicines for personal use may be imported into Germany from the countries of the European Union for a period of three months. In
addition to the statutory co-payment, anyone who buys prescription
drugs has to reckon with an additional flat rate and increased
administrative costs. As a result, cashing in a prescription in a pharmacy in a neighboring EU country is usually not worthwhile. Internet pharmacies from other European countries also offer discounts on prescription drugs. Health insurance companies usually do not cover the costs of non-prescription medicines. There are price differences within the European Union that patients can benefit from. Medicines
from countries outside the EU - for example Turkey or Thailand - may
only be imported when traveling in amounts that correspond to personal
needs. In principle, the health insurance companies do not cover any costs. In
addition, extreme caution is required when buying medicines outside of
Europe: there is a risk that counterfeit, unauthorized or incorrectly
dosed medicines will be delivered. Customs has further information on
bringing medicines from holiday countries:for trips to EU countries as well as for trips to countries outside the EU .
costs and billing
Planned treatment abroad can be settled in different ways. If you do not get approval from the health insurance company before the treatment, they will bill you according to the reimbursement procedure. Insured persons must first pay for all costs in advance. The health insurance company will only reimburse the costs after the treatment has been completed and the invoice for the services provided has been presented - but only up to the amount that would have been due in Germany for the corresponding treatment. The health insurance company automatically retains a share of the statutory co-payments from the patient and an additional item for the increased administrative effort from their subsidy.
- The invoice to be submitted to the cashier should be in German or, if necessary, in English. Otherwise patients have to pay for the translation costs.
- If the bill from the attending doctor in a neighboring European country is higher than in Germany, patients must pay the price difference themselves.
- All treatment items and individual amounts should be itemized in detail on the invoice.
- In principle, the health insurance company does not cover any costs for travel and accommodation.
In certain cases, the assumption of costs must be confirmed by the health insurance company beforehand. In addition, you can also apply in advance for cost coverage for services that do not require approval. Depending on the legal basis on which the billing is based, insured persons receive the benefits as a benefit in kind or by way of reimbursement of costs, either under foreign or German law. The health insurance company informs the insured which way is best for them.
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