Private practice in Berlin-Pankow Fees and reimbursement

Mine is a private practice for privately insured patients, people entitled to Beihilfe (the medical allowance for civil servants) and self-paying patients. If you have statutory health insurance, I support you in applying for cost reimbursement. I do not bill your health insurer directly. You receive an invoice from me.

I bill psychotherapy, but not coaching, under the official German fee schedule for psychotherapists (GOP). The fee for individual therapy may vary depending on the work involved.

How much you get back depends on your insurance and the rules that apply to you. It is best to clarify this before your first appointment.

Whether and how much your private health insurer reimburses for psychotherapy is set out in your policy. Policies differ widely. Some pay for a fixed number of sessions a year, others only for part of the invoice. Many require written approval after a few sessions. Some older policies only cover psychotherapy provided by doctors. New contracts often have a waiting period of eight months for psychotherapy.

You submit my invoice to your insurer yourself. If your policy only reimburses up to a certain rate of the fee schedule, you may have to pay part of the fee yourself.

If treatment is likely to cost more than €2,000, which is the case from about 14 individual sessions, you can ask your insurer in advance what it will cover. A letter or an email is enough. It must reply within four weeks, or within two weeks in urgent cases. These questions can help:

In the basic tariff (Basistarif), insurers usually only reimburse psychotherapy with therapists who have a statutory health insurance licence (Kassenzulassung), so not at my practice. The standard tariff (Standardtarif) has lower reimbursement rates. If you are insured under either of these tariffs, please let me know before your first appointment.

If you are entitled to Beihilfe, the rules for psychotherapy depend on the government you serve: federal civil servants follow the federal Beihilfe rules, Berlin civil servants those of the State of Berlin. If you serve another federal state, its rules apply. The federal and Berlin rules agree on the main points:

Beihilfe covers a fixed share of the eligible costs: 50, 70 or 80 per cent, depending on your personal situation. The rest is usually covered by your private health insurer. It has its own conditions, so please also ask your insurer whether you need approval. If either of them does not accept the full fee, you pay the difference.

Under the federal and Berlin rules, you can submit invoices up to three years after the invoice date. If you have opted for the flat-rate Beihilfe (pauschale Beihilfe) in Berlin, only your health insurer's rules apply to psychotherapy.

You can also pay for treatment yourself, however you are insured. You then need no application and no approval, and your insurer or Beihilfe office receives neither an invoice nor a diagnosis from me. We agree together how many sessions make sense, without any limits set by an insurer.

Please note: treatment you pay for yourself is still treatment. If an insurer or a public authority later asks you about psychotherapy, please answer truthfully. This can happen, for example, when you apply for private health insurance or occupational disability insurance (Berufsunfähigkeitsversicherung), or before being appointed as a civil servant (Verbeamtung). Having had psychotherapy does not automatically rule out appointment as a civil servant or an insurance contract. The body concerned decides case by case how it is assessed.

I am bound by professional confidentiality. I only share information with your consent or where the law requires it.

My practice does not have a statutory health insurance licence (Kassenzulassung). Even so, if you have statutory health insurance (gesetzliche Krankenversicherung), your health insurer can cover the cost of CBT with me in individual cases. This is possible if treatment is necessary and you cannot find a timely place with a therapist who has a statutory licence (Kassenpraxis).

You apply to your health insurer yourself, before treatment starts. I support you with this, among other things with a checklist and a template for your application. I cannot promise you approval, as your insurer assesses each application individually. Cost reimbursement applies to individual therapy. Statutory health insurers do not cover couples therapy or coaching.

This is usually how it works:

My templates to download, as a PDF to print or as a Word file to fill in:

Important: if you have already started therapy or firmly booked appointments before the decision, your insurer can reject the application for that reason alone. You will usually have to pay any costs incurred before its decision yourself.

Insurers often approve a few trial sessions first. You then apply separately for the therapy itself. How much your insurer reimburses per session is stated in its approval. If it reimburses less than my fee, you pay the difference. I will give you the expected costs in writing before we start.

You pay my invoices and submit them to your insurer, which then reimburses you the approved amount.

If your insurer or the Terminservicestelle offers you a place at a Kassenpraxis, please consider the offer seriously. If the timing and the journey are reasonable for you, cost reimbursement is usually no longer an option.

Please send me forms, medical reports and certificates by post rather than by email, as they contain information about your health.

Insurers and Beihilfe only reimburse the treatment of an illness. The following are usually not reimbursed:

You pay these costs yourself. For written statements and assessments, I will give you the expected costs in writing in advance.

An ADHD assessment, by contrast, clarifies whether an illness is present. Private insurers and Beihilfe may therefore reimburse it, depending on your policy and the rules. For group therapy, they often reimburse only part of the fee. In both cases, please check beforehand.