Services and elective services in hospitals

Every patient is entitled to all medically necessary hospital services that may be required to treat them.

In addition to medical treatment, these services include the care provided by nursing staff, as well as:

• accommodation in a shared room
• meals
• measures for the early detection of disease
• admission of an accompanying person or carer, if necessary

These general hospital services are covered by statutory health insurance funds. Treatment should be provided in accordance with the generally accepted latest medical research. If treatment by a senior consultant (i.e., physician) or accommodation in a private room is considered necessary for medical reasons, the health insurance fund will cover these costs also.

Rules for those with private insurance

Full medical insurance policies with private insurance providers cover the costs of general hospital services. The specific level of cover agreed in an individual policy determines the extent to which any additional services are also covered. Many private health insurance policies cover extras such as treatment by a senior consultant or the choice of a private hospital room.

For general hospital services, the charges are the same for people with statutory health insurance as for those with private health insurance in all state-approved hospitals. The hospitals charge at a flat rate for each case. The flat rates depend, for example, on the diagnosis and the severity of the case.

For people with statutory health insurance, the hospital settles bills with the health insurance fund directly. You only need to contribute an additional payment of 10 euros per day of your hospital stay. This is capped at 28 days per calendar year. This payment, known as a co-payment, must be made to the hospital directly.

Patients under the age of 18 are exempt from this co-payment. There are also other cases in which co-payment does not apply, for example:

• outpatient treatment or day patient treatment in a hospital
• inpatient birth
• if hospital treatment is covered by statutory accident insurance
• if the patient is exempt from the co-payment requirement

Reimbursement of costs in private health insurance

Privately insured patients usually pay the costs of medical treatment or medication themselves and then submit a claim for reimbursement to their insurance provider. However, they are not usually required to settle hospital bills in advance – when admitted to hospital, they can sign a declaration of assignment. This entitles the hospital to bill the patient’s insurance provider directly. 

Everyone with health insurance – either statutory or private – has the right to choose the hospital where they want to be treated. However, those with statutory health insurance must choose a hospital that is approved for the treatment of patients with statutory health insurance rather than a private clinic.

They can still choose a different hospital from the one specified on their referral, provided that it meets this criterion. The additional costs that arise as a result of their choice (for example, travel costs due to a longer distance) must be covered by the patients themselves. They do not have a say in which doctor in the hospital will treat them. This is decided by the hospital.

People with private health insurance can choose to be treated in any hospital or private clinic. The prerequisite is that the treatment must be medically necessary. A doctor’s referral is not required.

Elective hospital services are optional services that patients choose themselves. They include all extras that are not included in general hospital services, such as a private room, special meals and treatment by a senior consultant at the hospital, even if this is not medically necessary.

There are three categories of elective hospital services:

• Accommodation: A private room or double-occupancy room can be chosen instead of accommodation in a multi-bed room.
• Elective physician services: These include the option of choosing to be treated by doctors with specific qualifications. People most often choose to be treated by a senior consultant. However, it is not possible to select individual doctors. The elective physician service agreement always incorporates all other doctors involved in the treatment who can be selected on an elective basis. It is at the doctor’s discretion how the treatment will proceed. If a patient wants a particular treatment method to be used, elective medical services must also be agreed.
• Elective medical services: These include, for example, the choice of a specific diagnosis or treatment method, as well as treatment that is not medically necessary, e.g., cosmetic surgery. Medical services that are not essential to treating an illness also fall into this category. These include, for example, extended laboratory diagnostics or the use of additional alternative treatment methods.

Costs of elective services

The costs of elective physician services are based on the Medical Fee Schedule. The costs of elective services other than physician services are set by the hospitals themselves. People with statutory health insurance must pay for these themselves, unless they have taken out private supplementary care insurance policy. For people with private health insurance, elective services are often included at the level of cover agreed in their policy.

Due to the wide range of elective services, it is not always easy for patients to tell which are relevant for them or which are covered by their insurance. If you are considering availing of elective services, ensure that you obtain specific information about the costs in advance. The hospital has an obligation to provide you with clear information about the precise nature and costs of elective services both verbally and in written form. It is also obliged to make it known to you that, even if you don’t choose to avail of any elective services, all medically essential treatment will be provided to you by qualified doctors.

If you believe that the hospital did not inform you about the costs or did not provide sufficient information about costs before a contract was signed, you can legally contest the elective services agreement.

Advice is available from the Independent Patient Advice Service for Germany (Unabhängige Patientenberatung Deutschland, UPD), for example.

Many hospitals offer elective services to patients at the time of their admission. However, you don’t need to make this decision immediately if you aren’t ready to do so or if you’re unsure of what exactly you want to choose. If, however, you do want to avail of an elective service, a written contract is required. You can cancel this contract at any time, even while you are still in hospital. In this case, you are only required to pay for elective services provided to you up to the point of canceling the contract.

Supplementary hospitalization insurance

Private health insurance providers also offer policyholders the option of insurance cover that reimburses part or all of the costs of elective services. If you consider the extras associated with elective services to be generally important, it may make sense to take out this type of supplementary insurance. Before taking out a policy, ensure that you are well-informed and that you compare different options. There may be significant differences in the insurance plans on offer in terms of the premiums you will be required to pay and the services that are included.

It is the hospital’s responsibility to ensure that you will continue to be properly cared for after you are discharged. This means, for example, that the hospital must issue you with prescriptions for any medication, therapeutic products or patient aids that you will need for your first week at home. You must also be provided with information about who will continue to provide you with medical care and where you can go if you experience any complications.

If necessary, the hospital’s social services will provide you with information about support options at home or care options. Social workers can also help with submitting claims or contacting authorities.

For more information about follow-up care after a stay in hospital and what is involved in discharge management, see the website of the Independent Patient Advice Service for Germany (Unabhängige Patientenberatung Deutschland, UPD).

If you believe that you are not receiving the hospital services to which you are entitled, you can address your concerns to the ward manager/head nurse or the doctors who are treating you. If the issue is not resolved, you can contact Complaints Management or the patient advocate (ombudsman or ombudswoman) in the hospital. These are also the people to speak with if there is any issue with your hospital bill. For those with private health insurance, the insurance company will have an ombudsman or ombudswoman whom you can contact if you experience any problems with your insurance provider.