Self-Pay Patient Rights in IGeL Benefits: Understanding What You're Entitled To
In Berlin, certain medical services known as Individual Health Services (IGeL) are not covered by statutory health insurance. These services can include routine dental and vision care, many elective or non-urgent outpatient services, and certain non-covered ambulance transports [4][2].
Before opting for these IGeL services, it's crucial for patients to consider several important factors.
Firstly, understand what your statutory insurance plan does not cover. For instance, most standard health insurance plans exclude routine dental and vision care, meaning these must be paid out-of-pocket if needed [4].
Secondly, consider your financial responsibility. For services like air ambulance rides, patients may face high out-of-pocket costs, even with the protections of laws like the No Surprises Act [2]. High deductibles in many plans can also mean paying thousands before coverage begins [2].
Thirdly, be aware of legal protections and billing risks. The No Surprises Act and related state laws protect patients from surprise bills, but these protections do not universally apply, especially for elective or non-emergency self-pay services [1][5].
Fourthly, ensure you fully understand and document any consent forms or agreements. Signing forms in elective out-of-network services can waive protections against balance billing [1][5].
Lastly, if unexpected charges arise, be prepared for dispute resolution. Patients may have recourse through complaint processes and dispute resolution mechanisms outlined in federal and state laws such as the No Surprises Act [1][5].
It's also important to note that not all IGeL procedures can be assumed to be effective [6]. Examples of non-medically necessary IGeL include sports medical examinations, tattoo removal, couples therapy, and travel vaccinations [7]. Some self-pay services may cause more harm than good, according to the Medical Service of the Federal Government [8].
When considering an IGeL, take your time to gather as much information as possible. The "igel-monitor.de" portal provides information on various common self-payer services, but not all IGeL services are evaluated there [3]. The portal recommends asking questions such as the potential benefits, testing, risks, and costs of an IGeL [5].
Patients should also be aware that if a contract is not concluded before the treatment, they do not have to pay for the IGeL, even if they have received it [1]. It is advisable to check with your health insurance company in advance to see if they cover any IGeL services, such as travel vaccinations [9].
Doctors cannot make consent to an IGeL a prerequisite for a medically necessary treatment [10]. Patients must receive a written cost estimate in advance, listing the costs according to the fee schedule for doctors (GOÄ), before receiving an IGeL [11].
In conclusion, patients considering self-paid health services must verify statutory insurance exclusions, assess potential financial exposure, understand legal protections and consent implications, and be prepared for dispute resolution if surprise billing occurs. This informed approach helps manage the risks of paying out-of-pocket for services not covered by statutory health insurance.
References: [1] igel-monitor.de [2] No Surprises Act (2020) [3] Consumer Center [4] Statutory Health Insurance in Berlin [5] Medical Service of the Federal Government [6] Not all IGeL procedures can be assumed to be effective [7] Examples of non-medically necessary IGeL [8] Some self-pay services may cause more harm than good [9] Check with your health insurance company in advance [10] Doctors cannot make consent to an IGeL a prerequisite for a medically necessary treatment [11] Patients must receive a written cost estimate in advance
