Probatory

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The term probatorik (from the Latin probare = to try) means the initial sessions before the actual start of psychotherapy according to the psychotherapy guideline . Here the patient is asked about his complaint. The task of the psychotherapist is to clarify whether there is a mental disorder , if so which, how it is caused and maintained, whether it can be successfully treated with psychotherapy within a certain number of hours and how the therapy content should be structured. If long-term therapy is to be applied for with the statutory health insurance as part of a guideline procedure, the psychotherapist must always write an anonymous report with additional content, which is read and checked by an expert. The reviewer can approve, shorten, or not approve the therapy hours applied for. The patient’s opinion is sent to the patient’s health insurance company, which then decides on the application for therapy. The number of possible probatory sessions is limited by statutory health insurance. Often 5 trial sessions are carried out. It may take a few weeks for the application to be approved after the application has been submitted. A referral is not required for probatory sessions with a psychological psychotherapist or child and adolescent psychotherapist.

Probatorik as the beginning of psychotherapy

The start of psychotherapy begins with the so-called probatory sessions. During this time, the client / patient has the opportunity to find out whether the psychotherapist is a suitable one. During this period, it is clarified whether the intended psychotherapy is promising for the present mental disorder and whether the cooperation between the client and the psychotherapist is sustainable. If these conditions are met, an application will be made to the respective health insurance company. In order to clarify whether psychotherapy makes sense at all and whether the patient and the practitioner “fit” together, the health insurance company takes on up to four “probatory” sessions in advance, regardless of the therapy method chosen. Before April 2017, there were five or up to eight sessions, depending on the therapy method. You will be billed via the health insurance chip card . These "getting to know each other" sessions help the patient to calmly clarify whether he has found a suitable psychotherapist (e.g. therapeutic style, personality, gender).

Trial sessions are also planned for beneficiaries and for many privately insured persons . In the case of private insurance companies whose tariff only provides for a certain number of sessions per year, however, the distinction between probatory and normal sessions is not made. With some insurance companies, a detailed application for psychotherapy is required. A medical certificate of a relevant diagnosis is often sufficient here . Particularly with some aid agencies , it can happen that they defend themselves against the implementation of up to four trial sessions with different practitioners. They rely on the fact that the state aid rules only speak across the board of four trial sessions to be granted (without referring this formulation to one or more practitioners). The cost bearers concerned therefore take the position that it is a total number and not that one can claim up to four financed sessions per "tried" psychotherapist. However, this interpretation contradicts the meaning of the provisions. Because if a patient (or the psychotherapist, he also has the right to say “no”) only comes to the conclusion after 5 probatory sessions that both partners do not match, the patient would have no further chances of getting to know a new psychotherapist . On the other hand, it can be understood that a payer becomes skeptical if the same patient submits invoices over 40 probatory sessions to eight different practitioners.

"Application of the insured person for psychotherapy": "Fund application"

If the "Application of the insured person for psychotherapy" (PTV 1) is to be submitted by a psychological psychotherapist after the probatory analysis and any other necessary diagnostic clarifications, the confirmation of a doctor, the consultant report must be attached to the psychotherapist as part of the application process . The medical examination is intended to ensure that there are no physical reasons for psychological symptoms that would have to be treated medically. The report must be sent to the psychotherapist by the independent doctor no later than three weeks after the examination. All contract doctors with the exception of the following groups of doctors are entitled to submit a consultative report: laboratory doctors, microbiologists, infection epidemiologists, nuclear medicine specialists, pathologists, radiologists, radiation therapists, transfusion specialists and human geneticists. The psychotherapist must enclose the consultant's report in a sealed envelope with the report to the expert.

The application

The health insurance company determines the obligation to provide benefits for psychotherapy. For this purpose, the psychotherapist informs the health insurance company of the diagnosis on the form "Application from the therapist to the application from the insured person" (PTV 2), justifies the indication, specifies the type of treatment approach, and attaches the application from the insured person and the consulting report. The decision on the assumption of costs is then made on the basis of the opinion of an expert using the anonymised report of the treating psychotherapist, if the psychotherapist is not exempt from the obligation to provide an expert for the first 25 sessions. This can take a few weeks.

The therapy approval

The insurance carriers (e.g. statutory health insurances, private health insurances or allowances) only cover the costs for outpatient psychotherapy from the date of the express and written approval to the extent approved. The insured person and the psychotherapist each receive notification of this from the insurance provider. The psychotherapeutic treatment can only begin when the written assumption of costs is available.

The expert review process

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Psychotherapy as part of the reimbursement

If there is no contract handler available in a reasonable time for a "necessary" psychotherapy, because z. If, for example, the waiting times for a therapy place last longer than 3 months, the patient can submit an application to his health insurance company for reimbursement in accordance with Section 13 (3) SGB V. The psychotherapists' chambers of the respective federal state or the professional association of German psychologists (BDP) provide more information .

Psychotherapy procedures

So far, the restriction to three psychotherapy procedures applies:

The Scientific Committee recommended the psychotherapy in May 2002 psychotherapy and in December 2008, the Systemic therapy as "scientifically recognized procedure" in touch with.

There is freedom of choice for the patient.

Type, scope and implementation of the treatment

Both individual and group psychotherapy are possible in the outpatient setting. Billing takes place using the uniform evaluation standard . The time quotas for psychotherapy are fixed. After five (behavioral therapy and psychotherapy based on depth psychology) or eight (analytical psychotherapy) trial sessions, which are used to check the indications, short-term psychotherapy of up to 25 hours can be carried out. In the case of non-medical psychotherapists, a medical consultation report is also required before the start of therapy. a. certifies the absence of a physical illness and clarifies any questions about taking medication.

Privately insured

With some private insurance companies, the contracts stipulate that only a certain number of psychotherapy sessions are paid per calendar year, e.g. B. 25 sessions. In most cases, no distinction is made between probatory and regular sessions. So if you "try out" several psychotherapists with 5 probatory sessions each in such a case, you may already use your entire "annual contingent" and then have to wait until the next year with the actual psychotherapy or pay for the treatment yourself.

Probatorik as consumer protection

From the client's point of view, it is advisable to get to know the psychotherapist before starting therapy . In this respect, the up to five (VT) or eight (PA) probatory sessions are also considered trial sessions to check whether a sustainable working relationship can be established. Only after this phase, in which the psychotherapy goals and the treatment plan are discussed, an application for psychotherapy is made. A hasty or wrong decision about a psychotherapy place can also exacerbate the original problem. After discontinuing therapy, the approval of follow-up psychotherapy by the health insurance company may be questioned.

Social law / professional law

In Germany, psychotherapy is carried out by doctors (with appropriate psychotherapeutic training) or by psychological psychotherapists and child and adolescent psychotherapists . The Psychotherapists Act has been in force in Germany since 1999, and for the first time legally protected the professional title “Psychotherapist”. In addition to medical psychotherapists, for whom their own professional regulations apply, only qualified psychologists (for child and adolescent psychotherapy also qualified pedagogues or qualified social pedagogues) after successfully completing a state-recognized training, if certain requirements set out in the Psychotherapists Act are met who received the state license to practice as a psychological psychotherapist . On the other hand, naturopaths for psychotherapy are also allowed to offer and carry out psychotherapy in Germany .

The statutory health insurance and thus also its procedure with regard to psychotherapy is regulated in SGB ​​V. This includes guidelines that regulate psychotherapy in particular:

  • diseases requiring treatment
  • Appropriate procedures for treating illness
  • Application and review process
  • probatory sessions
  • Type, scope and implementation of the treatment as well as the medical consultant report

Services can be restricted or excluded "if, according to the generally accepted state of medical knowledge, the diagnostic or therapeutic benefit, the medical necessity or the economic viability have not been proven".

Austria

In Austria, psychotherapy is regulated in both the Physicians Act and the Psychotherapy Act of 1990.

Switzerland

In Switzerland, the health insurance approval of psychotherapeutic methods as described above is organized by the Swiss Charter for Psychotherapy , the Association of Swiss Psychotherapists , the Swiss Professional Association for Applied Psychology and the Federation of Swiss Psychologists .

See also

literature

  • Bärbel Schwertfeger u. Klaus Koch: The therapy guide. The main forms and methods. Heyne, Munich 2002, ISBN 3-453-09133-7 .
  • Rosemarie Piontek: companion in psychotherapy. 2nd Edition. Psychiatrie-Verlag, Bonn 2005.
  • Gerhard Stumm u. Beatrix Wirth: Psychotherapy, Schools and Methods. Falter, Vienna 2006, ISBN 3-85439-378-4 .
  • Gerhard Stumm u. Alfred Pritz (Ed.): Dictionary of Psychotherapy. Springer, Vienna 2007, ISBN 3-211-70772-7 .
  • Klaus Grawe , R. Donati a. F. Bernauer: Psychotherapy in Transition. Hogrefe, Göttingen 1994.

Web links

Individual evidence

  1. ^ Text version of the law
  2. ↑ Full text of the EEA Psychotherapy Act