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Patients with private health insurance

Costs for patients with private health insurance

Prices for patients belonging to private health insurance funds

For private patients, services are billed in accordance with legal requirements using the German fee schedule for physicians’ billing (GOÄ). The invoicing follows what is known as the ‘individual service principle’. Usually, what is known as a threshold value is used for private insurance patients in order to ensure that each respective partial service is appropriately reimbursed. The threshold value is 2.3 for general medical services and 1.8 for laboratory services.

Each individual service invoiced over this so-called threshold value needs to be justified. The use of a factor of less than 1.0 is not permitted. Lump sum prices and giving services away free of charge is also prohibited.

As for patients with German statutory health insurance (GKV), it is advisable (although not strictly required) to obtain confirmation of coverage from the health insurance fund before the start of treatment.

Unlike patients with German statutory health insurance, the couple does not need to be married, nor does the woman have to be under 40 years of age, for costs to be covered.

Coverage is conditional upon the following:

  • The partner with the private health insurance must be the “causer” of the sterility. The “causation principle” applies.
  • At least in cases when the woman is 40 years or older, various information is required to show that sterility treatment is “rational and offers prospects for success” in this woman’s case. For this purpose, information will be requested about the cycle and hormone levels, including AMH (Anti-Müllerian hormone). Generally, private health insurers will deny coverage to women 45 years of age and older.

Costs

  • Insemination cycle approx. 400.00 to 600.00 Euros plus the cost of medications (50.00 to 500.00 Euros)
  • IVF (conventional IVF) approx. 2,000.00 to 3,000.00 Euros plus the cost of medications (1,000.00 to 2,500.00 Euros)
  • Mini-IVF approx. 2,000.00 to 3,000.00 Euros plus the cost of medications (300.00 to 4,000.00 Euros), plus cryopreservation, if required
  • ICSI (konventionelle ICSI) approx. 3,500.00 to 5,500.00 Euros (based on ICSI for 5 egg cells) plus the cost of medications (300.00 to 4,000.00 Euros), plus cryopreservation, if required
  • Mini-ICSI approx. 3,500.00 to 5,500.00 Euros plus the cost of medications (300.00 bus 4,000.00 Euros), plus cryopreservation, if required

Additional services generally excluded from reimbursement:

  • HALO sperm test (180.00 Euros)
  • Cryopreservation of fertilised egg cells (approximately 400.00 Euros)
  • Rent for a storage period of 6 months (125.00 Euros)
  • Cryo cycles in order to transfer previously frozen fertilised egg cells (approximately 450.00 to 600.00 Euros), plus medication costs of approximately 100.00 to 500.00 Euros.
  • Assisted hatching (laser assisted embryo hatching): approximately 170.00 Euros
  • Polar body diagnostics:between 900.00 and 1600.00 Euros.