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Understanding individual healthcare services in Germany

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While the healthcare system is quite comprehensive and accessible, there are still medical procedures, tests or other treatments in Germany that are not covered by statutory health insurance providers.

Individual healthcare services (Individuelle Gesundheitsleistungen, or IGeL, in German) are additional services that doctors offer, but are not covered by statutory health insurance providers. Patients must pay out of their own pockets, which is why IGeL is also known as self-pay services.

Company health insurance fund Siemens-Betriebskrankenkasse explains individual healthcare services in Germany and how to decide whether to opt for IGeL.

What is IGeL, or individual healthcare services?

Services offered as IGeL comprise those that are deemed medically unnecessary, or those in which the risks outweigh any possible benefits; alternative medicine also falls under IGeL. German decision-making body the Federal Joint Commission (Gemeinsame Bundesausschuss, G-BA), which oversees healthcare regulations, determines which healthcare services should be covered by statutory health insurance, and which are IGeL.

The list of individual medical services offered changes regularly, as many are added and others drop out of use. In 2007, after extensive trials, acupuncture treatment for chronic lower back pain and knee osteoarthritis was approved as a treatment covered by statutory health insurance, but acupuncture for migraines or tension headaches still fall under IGeL.

The most common individual healthcare services include ultrasound examinations for cancer screenings, cosmetic procedures, or a combination of eye endoscopy and the measurement of intraocular pressure, which is purported to detect glaucoma as early as possible. The IGeL-Monitor website, published by the medical commission of the statutory health insurance association (MDS) and compiled by an interdisciplinary team of experts, outlines various IGeL medical procedures and treatments with an explanation of the procedure and cost estimates as well as a positive or negative rating, based on research. 

Inform yourself first, and then make a decision about IGeL

Customers who have been offered an individual medical service should not let themselves be pushed into having a procedure they don’t really need or want.

“It is best to not sign or pay anything, but to first take the information about the examination home with you. Take as much time as needed for your decision,” says Heinz-Ulrich König, who oversees outpatient care at Siemens-Betriebskrankenkasse. “Even if it is inconvenient, an IGeL offer should never be accepted without having checked it first. An IGeL is never so urgent that it should be done immediately.”

For example, detecting glaucoma early seems like an advantage – however, the IGeL-Monitor reports that the intraocular pressure measurement test may actually cause more harm than good. A study cited by the website showed that the examination does not reliably predict or diagnose glaucoma, and patients reported side effects from the examination itself. Furthermore, unnecessary examinations can decrease the patient’s quality of life, especially if the examination leads to a false diagnosis and further unnecessary treatment.

Many patients often opt to undergo additional individual healthcare services in order to be safe — or simply because they do not know enough about them, and instead rely on the doctors to make medical decisions on their behalf. It is crucial to inform yourself about the advantages and disadvantages of an examination, potential risks and the associated costs beforehand.

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Contact your health insurance provider first

Your first stop when considering IGeL should be your health insurance provider – even if they are not covering the procedure. Not all doctors will mention alternative procedures that are covered by your insurance for a particular condition. Additionally, some services sold as individual health care services to patients by doctors are actually covered by insurance, such as the measurement of bone density for osteoporosis patients and heart MRIs, among others.

“Naturally, patients cannot know all services their insurance covers,” König explains. “It is best to contact your health insurance first before paying for a service from your doctor. At some statutory health insurance providers, a personal consultant can tell you which services are paid by health insurers. If a certain examination is not part of the services paid by statutory health insurances, they can tell you about alternative examinations that are covered.”

Even though health insurance providers cannot influence a doctor’s recommendations or the services they offer, they can offer a considerable contribution to helping and supporting patients – especially when considering IGeL.

 

Siemens-Betriebskrankenkasse / Expatica

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