How the system of bills and the app works with private insurance
One of the most practical differences between public and private insurance is how payments to the doctor are handled. With private insurance, you get the bill at home, upload it to the app and the insurer reimburses you within a few days. Here's exactly how it works.
You don't pay at the appointment
With private insurance you get the bill by post and handle it from home, with no paperwork at the time of the visit.
Private insurance works differently from public insurance
In the German public system, the doctor bills the insurer directly. You show your health card and don't have to deal with anything else. The system is convenient, but it limits your visibility over what each treatment costs and what your insurance covers.
In private insurance it works differently. You're the point of contact between the doctor and the insurer. The doctor sends the bill to you, you pay it and then you claim it back from your insurer, which reimburses the amount to your bank account in around five days.
This system has an important advantage that isn't always mentioned: you have full control over which bills you submit and when. That lets you, for example, decide not to submit small bills in order to keep the no-claims bonus many private insurers offer.
In the private system you need short-term liquidity: you pay the doctor's bill first and then recover that money from the insurer. It isn't an extra cost — it's a temporary gap of a few days that's worth bearing in mind from the start.
How it works from the appointment to the reimbursement
The process is simpler than it seems. Once you've done it once, it becomes completely natural.
1. You go to the appointment
You see the doctor or specialist with your private insurance card. You don't need to pay anything at the time of the visit. The doctor sees you and, once the appointment is over, prepares the bill.
2. You receive the bill by post
Roughly 5 to 10 days after the visit, you'll receive the bill at home by post. It shows the breakdown of the treatment, the total amount and the payment deadline, which is usually two weeks to a month from receipt.
3. You photograph it and upload it to the app
Before paying the doctor, photograph the bill with your phone and upload it directly from the insurer's app. The process takes less than two minutes. The app is designed to be as quick as possible: open, photograph, send.
4. The insurer reimburses you in ~5 days
Once the bill is processed, the insurer transfers the covered amount directly to your bank account. Usually within about five working days. In the app you can track the status of your claim in real time.
5. You pay the doctor with the money received
Once you have the reimbursement in your account, you make the transfer to the doctor. That closes the cycle. In practice, the doctor doesn't pressure you to pay immediately and the deadlines are wide enough for everything to fit together stress-free.
What if the bill is very high? Hospital stays and operations
The 5-step process you've just seen works perfectly for appointments, tests and day-to-day treatments. But when it comes to a hospital stay, an operation or any high-cost treatment, the system works differently — and much more favourably for you.
The idea that with private health insurance you always have to pay upfront is one of the most common misunderstandings. In reality, for higher-value treatments there are specific mechanisms that avoid exactly that.
In practice, nobody is paying 20,000 € out of their own pocket with no solution. The system is set up for higher-cost cases, and there's always a way to resolve it without it becoming an immediate financial problem.
The hospital bills the insurer directly
For hospital stays and operations, the most common arrangement is that the hospital doesn't bill you, but bills your private insurer directly. You sign the necessary documents on admission and don't have to pay anything upfront. The hospital and the insurer handle it between them.
You can submit the bill before paying it
If you receive a high-value bill, you don't have to pay it before receiving the reimbursement. You can send it to the insurer as soon as you get it and wait for them to transfer the amount before paying the doctor or clinic. The usual payment deadlines give you enough room for this.
Direct payment or deferral
If for any reason you need more time, you can ask the hospital or clinic to defer the payment, or ask the insurer to pay the provider directly. Both options are common and medical centres are used to handling them with private insurers.
The deductible only affects small bills
If your plan has a deductible, remember it applies to the annual total of bills submitted — not to each bill separately. In major hospital stays, the deductible represents a tiny fraction of the total cost, and the insurer covers the rest without any problem.
The insurer's app: everything in one place
With your policy number you can access the app from day one. It's the central tool for managing your private insurance with no calls or paperwork.
From the app you can upload bills for reimbursement, check the status of your claims, access all your digital documents and policies, manage additional services like Health Coaching or finding a doctor, and review your reimbursement history.
Everything that used to arrive by post — certificates, notices, policy updates — is also available in the app in digital format. Less paper, more control.
Do you have to submit every bill? The strategic bonus decision
No. You can decide which bills you submit and which you don't — and that decision has real financial implications.
Many insurers refund between 600 € and 1,400 € of the premiums paid if you don't submit any bills during the year. This leads to a common practical decision: when you have a small bill — a 60 € appointment, a 90 € blood test — it may suit you better to pay it directly out of pocket than to submit it to the insurer, in order to keep your right to the annual bonus intact.
The calculation is simple: if the bonus you'd get back exceeds the cost of the small bills you won't submit, you're better off not submitting them. It's an advantage exclusive to private health insurance that the public system never offers.
What to be clear about before you start
These are the most common questions about the billing system that are worth resolving before taking out private insurance.
Liquidity for medication
The only time you usually pay upfront is for prescription medication. After your appointment, you take the prescription to a pharmacy and pay for it yourself; the reimbursement is processed shortly after, so you only cover the cost for a brief period.
You decide what you submit
You're not obliged to submit every bill. If during the year you have no significant medical expenses, you can choose to submit nothing and receive the no-claims bonus, which can mean several hundred euros refunded.
Everything from your phone
The app is designed to make the process as smooth as possible. You photograph the bill, send it and you're done. You don't need a scanner, you don't need to print anything or go to any office. The whole process from your phone.
Deductible, if you have one
If your plan has an annual deductible, the insurer will deduct that amount before reimbursing you. A higher deductible reduces your monthly premium, but it means you cover the first medical costs of the year yourself.
Can you switch to a different private health insurer later?
Yes, but there are conditions worth knowing from the start. In most contracts, you can't switch insurer for the first 24 months. After that period, you can request a switch to another PKV with 3 months' notice before 1 January of the following year.
The important thing is that when you switch from one PKV to another, you can take with you the reserves built up during your time insured. This protects your long-term investment and gives you flexibility if you find better terms in the future.
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