Choosing a doctor and finding an appointment: obtaining help from the right people

All patients have the right to choose their doctor. This applies to both people with statutory health insurance and people with private insurance, including in the case of dental and psychotherapeutic care services. However, members of the statutory health insurance providers can only choose doctors who have been approved by the health insurance provider as affiliated doctors. These are also referred to as health-insurance-provider-approved doctors.

The free choice of doctor also includes hospital doctors that offer outpatient treatments – providing they have entered into an agreement with the health insurance providers in relation to such services. Outpatient means that people can go home following the treatment rather than having to stay the night in hospital. People with statutory health insurance can only attend private practices in emergencies.

Further restrictions to the free choice of doctor apply in the event of occupational accidents. In this case, you must initially visit an accident insurance doctor (D-doctor) so that the cost of any treatment can be settled via the statutory accident insurance. Accident insurance doctors are doctors who have been specially approved by the German Employers’ Liability Insurance Associations (“Berufsgenossenschaften”). 

In the event of medical or psychotherapeutic treatment, you must always present your electronic medical data card (eGK) or other proof of insurance (e.g. a treatment certificate). These enable the costs to be settled with the health insurance providers or other cost bearers. People with private insurance have to initially settle the bill for the doctor’s visit themselves before later having the costs reimbursed by their insurance provider.

The right to freely choose a doctor generally also applies to specialists. Aside from a few exceptions, patients can find a specialist directly without needing a medical referral. 

For many people, however, the general practitioner is the first point of call for health problems. Ideally, general practitioners will have known their patients for a while and be familiar with their medical history. In the case of specific problems, they can determine whether specialists should be consulted. General practitioners provide specialist referrals 

• if a specialist is needed to provide a certain service (contracted service), such as x-ray scans.
• if a specialist needs to perform additional examinations (consultative examinations) in relation to a tentative diagnosis.
• if another doctor should be involved in the treatment or take over the treatment entirely (co-treatment or further treatment).

The general practitioner should coordinate the examinations and help avoid unnecessary duplicate examinations. As such, general practitioners take on the role of “pilot” within the healthcare system. If you take several types of medication that have been prescribed by different doctors, a general practitioner can help to ensure the medication’s compatibility and prevent interactions.

People with statutory health insurance require a referral from their doctor for appointments with certain specialists. Doctors who specialize in laboratory medicine, radiology, radiotherapy, transfusion medicine, microbiology, nuclear medicine and pathology can solely be consulted upon referral. Referrals are usually also required for outpatient treatment in hospitals.

Referrals can also be needed if specialists believe that an examination or treatment type is needed that falls outside their specialist areas, i.e. from other specialists. For example, if orthopedic specialists need magnetic resonance imaging (MRI) scans of a knee, they will issue a referral for radiology.

Referral validity

Although issued for the current quarterly period (quarter), medical referrals are valid across quarters. In other words, even if the treatment by a specialist only starts during the next quarter, no new referral is required. Presenting the electronic medical data card suffices. If the treatment by the specialist lasts for longer than a quarter, the initial referral can also be used across multiple quarters.

In the case of specialists in particular, it can sometimes be hard to get an appointment quickly. The following services can help you find a doctor’s appointment:

Online doctor search: use the gesund.bund.de doctor search to find doctors and psychotherapists in your area.

Dentist search: the Association of Statutory Health Insurance Dentists (Kassenzahnärztliche Bundesvereinigung – KZBV) provides a useful search function that can help you find a dentist.

Another option for urgent cases is that of open consultation hours: specialists who are classed as offering primary care for patients are usually obliged to offer at least five open consultation hours per week. These include specialists in the following disciplines:

• Ophthalmology
• Surgery
• Gynecology
• Otorhinolaryngology
• Dermatology (skin disorders)
• Pediatric and adolescent psychiatry
• Neurology
• Neurosurgery
• Orthopedics
• Psychiatry
• Urology

No appointment is needed for these consultation hours.

Appointment service

Anyone who receives a referral with an arrangement code (Vermittlungscode) or referral code (Überweisungscode) – also known as an urgency code (Dringlichkeitscode) – can use the regional appointment service centers provided by the Associations of Statutory Health Insurance Physicians (Kassenärztlichen Vereinigungen). The service centers act on behalf of people with statutory insurance by arranging appointments for them with specialists as well as for psychotherapeutic consultations and, in the event of a confirmed need for treatment, appointments for acute psychotherapeutic treatment.

Appointments for psychotherapeutic consultations as well as with gynecologists and eye specialists are also arranged without referrals. The appointment service centers also help people to find pediatric doctors and general practitioners – again without a referral. It is not possible to arrange appointments with specific doctors via these centers. The appointments are arranged on the basis of a set area search.

The appointment service centers have up to a week to arrange an appointment within four weeks. Patients should not have to wait more than two weeks for appointments for acute psychotherapeutic treatments. If it is not possible to arrange an appointment, patients should be offered an outpatient treatment appointment in a hospital. 

Appointments can be arranged with the appointment service centers by calling 116 117 or online via the e-appointment service provided by the Associations of Statutory Health Insurance Physicians. The twelve-digit arrangement code must be provided when arranging the appointment.

Can practices simply reject patients?

Doctors who can treat people with statutory insurance and who are therefore approved as affiliated doctors have a duty to provide treatment. However, treatment can be declined for valid reasons – providing it is not an emergency. Examples of such reasons include treatment capacities having been exceeded or the relationship of trust between the doctor patient having been destroyed. The latter can be the case, for example, if the patient does not follow medical instructions or abuses practice personnel. Patients who do not present a medical data card can also be rejected. However, emergencies must always be treated.

The non-emergency medical assistance service is responsible for situations in which you would usually visit your medical practice but treatment cannot wait until the next day for medical reasons. The addresses of non-emergency medical assistance practices in your area can be obtained at night or at the weekend by calling 116 117. Alternatively, the hotline staff will send a doctor to your home. 

Non-emergency medical assistance practices near you can also be found online using the search function provided by the non-emergency medical assistance service of the National Association of Statutory Health Insurance Providers (Kassenärztliche Bundesvereinigung). 

Hospital emergency departments are not responsible for such situations. They should only be used in the event of genuine emergencies. 

In the event of a sudden onset of severe pain or life-threatening situations, you should immediately call an ambulance on 112 or make your own way to a hospital emergency department. Examples of emergencies include:

• severe chest or stomach pain
• severe shortage of breath
• heavy bleeding or severe burns
• reduced consciousness or loss of consciousness
• bone fractures
• allergic (anaphylactic) shock
• slurred speech
• paralysis 
• sudden complications during pregnancy

People can sometimes be unsure whether to go to the emergency department. In such situations, it is advisable to call the non-emergency medical assistance service on 116 117 to clarify the best course of action. 

Full information on points of contact in emergencies can be found in the overview of numbers to call in the event of an emergency.