How to submit a claim
In Germany's private health insurance system, you pay your doctor first, then get reimbursed by your insurer. Here's how that works — and the small details that catch most expats off guard.
The process, in four steps
- 01
Book the appointment and visit the doctor
See your doctor like normal. At a standard practice you never pay in the room — the practice sends you the invoice (Rechnung) by post, usually a few days to a few weeks later.
- 02
Submit the invoice to your insurer
Once the invoice arrives at home, you pick one of four channels. Any of them works — the result is the same, only the speed differs.
Your insurer's app
Photograph, upload, done. Fastest — most clients today use this.
Email to the insurer
Attach a PDF or photo to their claims address.
Post
Send the original by mail. Still accepted, rarely needed.
Email to us
If you're our client, forward it. We check the billing first, then pass it on — no extra cost.
- 03
The insurer reviews
They check the invoice against your tariff, the GOÄ (official doctor fee schedule) and your diagnosis. A clean match is approved quickly. If something looks off — an unusual fee multiplier, a service that doesn't fit the diagnosis — they'll ask follow-up questions either to you or to the doctor.
- 04
Reimbursement lands in your account
For a straightforward invoice, within 24 hours is realistic. For something that needs back-and-forth with the doctor, up to 14 business days. The money goes to the bank account on file with your insurer.
Three things that trip people up
Small details that can get a claim denied or reimbursed at a lower rate. Worth knowing before your first appointment.
Heilmittel usually need a prescription
Most tariffs require a prescription (Rezept) from a GP or relevant specialist to reimburse physiotherapy, occupational therapy (Ergotherapie), speech therapy (Logopädie) and similar Heilmittel. Without one, the insurer typically reimburses at a reduced rate — or not at all, depending on the tariff. A few high-end tariffs waive this requirement.
Primärarztprinzip tariffs need a referral
Some PKV tariffs include a GP-gatekeeper model in exchange for a lower premium. If yours does, always see your GP before a specialist — or the specialist's invoice is only reimbursed at a reduced rate.
Pharmacy receipts are a separate claim
The pharmacy receipt (Apothekenquittung) is a different claim from the doctor's invoice. Submit them as individual items so each is processed correctly.
What you need
- The original invoice (Rechnung) from the practice
- Your insurance policy number (Versicherungsnummer)
- Bank details on file with your insurer
- A referral letter or prescription, if applicable
- Your submission channel of choice — app, claims email, or our broker inbox
Money-saving habits
A few things that regularly save our clients real money — over years, often more than the premium difference between tariffs.
Beitragsrückerstattung: cashback for a quiet year
Many PKV tariffs reward a claim-free year with 1 to 6 months of premium refunded. For small out-of-pocket costs, paying yourself and keeping the cashback often comes out ahead. Good to know: higher-end tariffs reimburse preventive checkups without counting them against your cashback — worth confirming what yours allows.
A long wait usually means questions
If reimbursement is taking more than a week, the invoice is likely under review. The insurer has either asked the doctor for clarification or is waiting on something. A quick call tells you where it stands.
Have a question about a specific invoice?
We review client invoices as part of our service. Book a free call with Jonas — we’ll walk through yours together.
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