Private doctor
A private doctor is a doctor who only treats private patients and self-payers.
In contrast to the contract doctor, the private doctor is independent of the requirements of the Social Security Code . The patient is treated independently of the bodies ( Joint Federal Committee (GBA), statutory health insurance (GKV) and statutory health insurance associations (KVen)). Thus - except in emergencies - there is no entitlement to treatment for those with statutory health insurance. A private doctor is licensed by the regional council and is a compulsory member of the responsible medical association . The private doctor, like all doctors, is bound by professional law . The private doctor is one of Germany's liberal professions , as well as in Austria to the liberal professions belongs.
Reward
The doctor's fee must be calculated according to the fee schedule for doctors (GOÄ). This follows from § 612 BGB, according to which if there is a rate - the GOÄ is considered a rate - this is to be applied. In particular, it is subject to Section 1 (2) GOÄ:
“The doctor may only charge remuneration for services that are required for medically necessary medical care according to the rules of medical art. He may only charge for services that go beyond what is medically necessary medical care if they have been provided at the request of the payer. "
The fees are calculated by multiplying a rating number by the valid point value (e.g. detailed advice lasting more than ten minutes, item 3, basic fee 8.73 euros). This fee is multiplied by an increase factor depending on the effort.
“Within the framework of fees, the fees are to be determined at reasonable discretion, taking into account the difficulty and the time required for the individual service as well as the circumstances during the execution. The difficulty of the individual performance can also be due to the difficulty of the illness; (§ 5 Abs. 2 GOÄ). "
The fee range is between 1 and 3.5 times the rate. The factor can also be agreed differently by means of a fee agreement. The patient has to pay the fee invoice to the private doctor and can then submit it to his private health insurer for reimbursement.
Private medical patient
In contrast to cash patients, who reveal themselves as such by presenting their health insurance card or electronic health card, a treatment contract is concluded - mostly verbally - between the doctor and private patient . This does not affect a possible. Insurance contract of the private patient with a private health insurance.
As a secondary obligation under the treatment contract, the doctor has the duty to support the patient with the reimbursement. He should therefore prepare a cost estimate for more extensive (more expensive) treatments and inform the patient that he should obtain a declaration of cost coverage from his private health insurance company. However, the dentist's obligations do not go so far as to have the patient submit the insurance contract or the cost assumption declaration from the private health insurance provider or to advise him on insurance law. This is also the case with the large number of private dental insurance tariffs on the market, the different contractual clauses, different amounts of deductibles , waiting times , graduated tariffs, tariff exclusions, individual benefit exclusions and the like. v. a. not possible.
Over half of all private patients are eligible. Different aid guidelines apply here , which are also difficult to understand for a patient. Here, too, there are exclusions from benefits, reimbursement restrictions and different aid rates.
Statutory insured persons can - waiving their entitlement to benefits in kind from statutory health insurance - also be treated as private patients. They are also called "self-payers".
Target performance principle
The target performance principle is a term from the private fee schedule for doctors (GOÄ) or the private fee schedule for dentists (GOZ) and aims to avoid double fees for medical services. In § 4 para. 2a GOÄ it says:
“The doctor cannot charge a fee for a service that is part of or a special implementation of another service according to the schedule of fees if he charges a fee for the other service. This also applies to the individual operational steps that are methodically necessary to provide the operational services listed in the schedule of fees. "
Medical malpractice
When suspicion of malpractice in the private medical field a medical private opinion may by an expert to help you.
The following are possible for out-of-court clarification:
- Conversation between the patient and the treating doctor
- Direct negotiation between the lawyer and the doctor's liability insurance
- Arbitration bodies of the medical associations; however, the procedure before an arbitration board only starts if the doctor involved agrees to the arbitration procedure.
In addition, the civil courts are open for judicial clarification .
