Statutory health insurance patients: Earlier doctor’s appointments for money: Is that allowed?

A ruling by the Düsseldorf Regional Court made it clear that doctors are not allowed to offer those with statutory health insurance earlier appointments for an additional charge. photo

© Benjamin Nolte/dpa-tmn

Months pass before the appointment at the specialist’s office: those with statutory health insurance know this well. What if the doctor offers an earlier appointment – but for money? A court has ruled on this.

An earlier appointment within the health insurance office’s office hours for an additional charge of 150 euros: Doctors are not allowed to make such an offer to those with statutory health insurance. This is shown by a ruling by the Düsseldorf Regional Court (ref.: 34 O 107/22), which was pointed out by the North Rhine-Westphalia consumer advice center, which itself had sued.

Pay – or wait several months

Specifically, it was about an ophthalmologist who had also offered self-pay appointments to people with statutory health insurance via an online booking portal. A statutory health insurance patient should pay 150 euros for an earlier eye doctor appointment that his wife had booked for him – or wait several months. A practice employee informed the woman about this by telephone after booking online. Ultimately, the woman canceled the appointment for her husband.

The man contacted the consumer advice center, which, according to its own statements, warned the ophthalmologist. Because the doctor decided not to sign a cease and desist declaration, the case ended up before the Düsseldorf Regional Court.

Consultation hours for statutory health insurance patients

The court decided: The ophthalmologist must refrain from offering such appointments in the future. Crucial part of the reasoning: The appointment for an additional charge would have taken place within the consultation hours set aside for those with statutory health insurance. The background is that contracted doctors are obliged to be available for statutory health insurance patients at least 25 hours per week.

In its ruling, the court also referred to the applicable professional regulations for doctors. Accordingly, they are not permitted to demand gifts or other benefits from patients “if this creates the impression that the independence of the medical decision is influenced.” The ophthalmologist violated this rule.

Other ways to get a quicker doctor’s appointment

But of course there is great frustration when you can’t see yourself in a specialist practice for many months – and there may be a temptation to “buy” an earlier appointment. However, consumer advocates advise against this – and point to alternatives: There is the option of having your family doctor refer you to a specialist practice. A so-called urgency code can be used for this.

The appointment service points of the Association of Statutory Health Insurance Physicians can also help you when looking for a specialist appointment. This can be done via the telephone number 116117 or via the app of the same name.

In emergencies, there is the option of attending open consultation hours for which no appointment is required. Contracted doctors must set aside at least five hours a week for this.

dpa