Cost reimbursement

PSYCHOTHERAPY THROUGH COST REIMBURSEMENT

If you have statutory health insurance and, despite documented efforts, cannot find a timely treatment place with a psychotherapist approved by statutory insurance, your health insurer may, under certain conditions, cover the cost of treatment at my practice. This procedure, known as Kostenerstattung (cost reimbursement), is governed by § 13 (3) SGB V.

When can cost reimbursement apply?

As a rule, you are entitled to cost reimbursement if necessary treatment cannot be provided in time, if the treatment cannot be postponed, or if your insurer has wrongly refused a service. What matters is that you have demonstrably and unsuccessfully tried to find a timely treatment place with a psychotherapist approved by statutory insurance, for example through the appointment service (Terminservicestelle, 116117) or directly with practices approved by statutory insurance.

How to apply for cost reimbursement

01. Contact my practice

First, you get in touch with me. In a short preliminary phone call, we clarify whether I can offer you a treatment place and whether cost reimbursement might be an option in your situation.

02. Choosing the right route

We then discuss how the first sessions will take place. You can first apply to your health insurer for coverage of treatment at my private practice. Alternatively, initial sessions can take place on a self-pay basis while the next steps for cost reimbursement are being clarified.

03. Preparing the application

If you decide to pursue cost reimbursement, I will give you detailed instructions and the necessary documents. You will also need proof that, despite your efforts, no timely treatment place is available at a practice approved by statutory insurance.

04. Application and further treatment

Once the requirements have been clarified, the necessary documents are submitted to your health insurer. Further treatment at the expense of your statutory insurer should only take place once coverage has been clarified or approved.

Your documents, step by step

The cost reimbursement procedure involves several steps and documents. To help you keep track, you will find detailed instructions here. Please go through the points in order. You can download the templates you need directly. The forms and templates are in German, as they are submitted to German health insurers. Documents that I prepare do not, of course, need to be prepared by you.

What to do now

First, make an appointment for a psychotherapeutic consultation (psychotherapeutische Sprechstunde) with a psychotherapist approved by statutory insurance. You can get an appointment, for example, through the appointment service 116117 .

The consultation clarifies whether psychotherapeutic treatment is needed. Afterwards, you will receive the form PTV 11 (“Individual patient information on the outpatient psychotherapeutic consultation”)

Important for cost reimbursement

If timely psychotherapeutic treatment is necessary, this should be documented accordingly on the PTV 11. Be sure to keep the form, as it can be important evidence for your application. The exact requirements, however, depend on your health insurer and your individual case.

What you do yourself

Make an appointment for a psychotherapeutic consultation → attend the consultation → ask for the PTV 11 → keep the form.

Please keep the original PTV 11. You will need the information later when putting together your documents for cost reimbursement.

What to do now

For cost reimbursement, you need to show your health insurer that you have tried to find a therapy place with psychotherapists approved by statutory insurance but cannot receive timely treatment there.

To do this, contact several practices approved by statutory insurance and note down for each:

Name of the practice
Date of your enquiry
How you made contact, e.g. by phone or email
The practice’s response
the waiting time given, if any

You can also document unsuccessful attempts to make contact.

Good to know: Under § 13 (3) SGB V there is no generally applicable legal number that is binding for every insurer and every case. So ask your health insurer how many documented refusals it requires.

Please document your enquiries from the start.

To help you keep track, you can use the prepared documentation list. You will later submit it to your health insurer together with the other documents.

What to do now

Contact your health insurer and explain that, despite your efforts so far, you have not been able to find a timely therapy place with a psychotherapist approved by statutory insurance.

Ask your health insurer explicitly which documents it needs for an application for psychotherapy through cost reimbursement under § 13 (3) SGB V.

Ideally, ask for this information in writing, or ask them to send you the necessary documents and instructions by email or post.

What you can tell your health insurer

“I need outpatient psychotherapy and, despite my efforts so far, have not been able to find a timely treatment place with a psychotherapist approved by statutory insurance. I have the option of starting treatment at a private practice with a licensed psychological psychotherapist. Which documents do you need from me for an application for cost reimbursement under § 13 (3) SGB V?”

Please make a note of:
On which day did you speak to your health insurer? With whom? Which documents were requested? If possible, ask for any special requirements to be confirmed in writing.

What to do now

You will need various documents for cost reimbursement. Which proof your health insurer requires can vary from case to case. Here you can put together the most important documents step by step.

Your checklists

The cost reimbursement procedure has two phases. Please only use the checklist that matches your current step.

A · Before the initial assessment sessions

Application for reimbursement of the initial assessment sessions→Checklist A · Download PDF ↓

B · After the initial assessment sessions

Application for psychotherapy →Checklist B · Download PDF ↓

Documents for your application

Please refer to the relevant checklist to see which documents you need and when. Please do not download all forms in advance.

  1. Documenting your search for a therapy place
    Here you document your previous attempts to contact psychotherapy practices approved by statutory insurance.
Documentation list for your therapy search →Download PDF ↓
  1. PTV 11 from the psychotherapeutic consultation
    You receive this form at a psychotherapeutic consultation. Please keep it and enclose it with your application. → No download needed
  1. Applications for cost reimbursement Please only choose the template that matches your current phase and the treatment method we have agreed on. Add your personal details and your health insurer’s address. Then check and sign the application.
Template: application for reimbursement of initial assessment sessions→Download PDF ↓
Template: application for reimbursement of psychoanalytic therapy→Download PDF ↓
Template: application for reimbursement of psychodynamic psychotherapy→Download PDF ↓
  1. Medical examination and consultation report (Konsiliarbericht) A medical assessment is required before further psychotherapy begins. I will give you the necessary documents during the process. Your doctor carries out the examination and writes the consultation report. An additional medical statement on urgency can support the application if particular urgency is medically justified or your health insurer requires such proof.
Template: medical statement on urgency →Download PDF ↓
  1. Further forms, only if needed Depending on your health insurer and the individual course, additional documents may be needed. Please do not use these forms in advance, only after feedback from your health insurer or after we have agreed on it together.
  • Proof from the appointment service
    To document unsuccessful referral attempts via 116117.
Template: proof from the appointment service TSS 116117 →Download PDF ↓
  • Release from confidentiality (Schweigepflichtentbindung)
    Only needed if direct communication between my practice and your health insurer is necessary or has been agreed.
Template: release from confidentiality for cost reimbursement→Download PDF ↓
  • Assignment declaration (Abtretungserklärung)
    Only after approval has been granted and if direct billing with the health insurer has been agreed.
Template: assignment declaration for cost reimbursement→Download PDF ↓

Please do not send an incomplete application.

We will agree together which documents your health insurer specifically needs and when the application should be submitted. Please bring all the documents you already have to our sessions.

Frequently asked questions about cost reimbursement

If, despite necessary treatment, no timely therapy place can be found at a practice approved by statutory insurance, you can apply to your statutory health insurer for coverage of treatment at a private practice. The insurer reviews each application individually, so coverage cannot be guaranteed.

Yes. Please ask your health insurer early on about the specific requirements. As a rule, only start treatment that you will be charged for once coverage has been confirmed in writing. The initial assessment sessions and the subsequent psychotherapy may require separate applications.

The psychotherapeutic consultation (Sprechstunde) serves as an initial diagnostic assessment. It examines whether a mental health condition may be present and which treatment is recommended. The result is recorded on the PTV 11 form.

You receive the PTV 11 at a psychotherapeutic consultation at a practice approved by statutory insurance. As a rule, you do not need a referral for the consultation.

There is no generally binding number. Requirements can differ depending on the health insurer and the individual case. So document your attempts to make contact as completely and clearly as possible. You are welcome to use the documentation list provided.

Initial assessment sessions (probatorische Sitzungen) take place before the actual psychotherapy begins. Among other things, they serve to get to know each other, to clarify the diagnosis, to plan treatment and to decide whether working together in psychotherapy makes sense.

With a psychological psychotherapist, a medical examination and a consultation report are required before further psychotherapy begins. I will give you the relevant documents during the process. The consultation report is written by a doctor after a personal examination.

No. An additional medical statement on urgency can support the application if particular urgency is medically justified or your health insurer requires such proof. It does not replace the consultation report.

No. Whether and to what extent costs are covered is decided by the health insurer in each individual case. The written approval is what counts. Costs that are not covered may have to be paid by you. We will discuss this openly before treatment begins.

First, check the reasons and information in your decision letter. As a rule, you can file an objection (Widerspruch) against a rejection. Whether this makes sense in your case and which deadline applies is stated in the information on legal remedies (Rechtsbehelfsbelehrung) in your decision letter. You are welcome to discuss the next steps with me.

These forms are not submitted in advance. A release from confidentiality may be needed if direct communication between my practice and your health insurer is agreed. An assignment declaration only comes into question after written approval and if direct billing has been agreed.

Wohnliches Behandlungszimmer für die tiefenpsychologisch fundierte Psychotherapie

Whether treatment is possible can be clarified in the first consultation. Please do not send any applications or medical documents by email in advance.

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