Chief physician treatment in private health insurance: an optional hospital service

At its core, it is about the right to bill privately. Chosen physicians may bill their services privately under the fee schedule for doctors, in addition to the general hospital services that every hospital provides regardless of insurance status. The optional services agreement is a separate contract with the hospital and must be signed in writing before the treatment. It does not cover services provided before it was signed.

Medically, the agreement guarantees personal treatment by the named chosen physician for the essential services. The physician may delegate, but must perform the core services personally. Otherwise the right to the fee lapses. This personal responsibility, not a better medicine, is what the optional service is about.

The fees of the chosen physicians depend on the type and scope of the treatment. A medium-sized operation with a stay of a few days typically adds up to €1,000 to €2,500, split between surgeon, anesthesia and diagnostics. The benchmark is the fee schedule for doctors. 2.3 times the fee rate counts as the standard maximum fee rate. Up to 3.5 times the rate, the doctor needs a written justification. Above that, an individual fee agreement with the patient is needed.

For a plan comparison, this means that a chosen physician clause that only reimburses up to the standard maximum fee rate does not cover the reality of many chief physician bills. Strong plans reimburse up to the maximum rate, and top-tier plans also above it, as long as there is a valid fee agreement. These amounts are guide values. What counts is the plan and the individual case.

From supporting clients through hospital cases, we see two typical disappointments. The first is a missing optional services agreement on admission, often in the stress of an unplanned admission. The second is a fee agreement above the maximum rate that the plan does not cover. Both can be avoided with a few minutes of attention on the day of admission.

We recommend that you decide on the chosen physician together with the room type. Together, these two optional services make up the difference in comfort in hospital, but each can also be insured separately. If you rarely need to go to hospital and can do without a chosen physician, choose a plan with a hospital daily allowance as a replacement benefit and keep your flexibility.

No. The general hospital services ensure the same medical care for all patients. The optional service guarantees personal treatment by an experienced, named doctor, which people value above all for complex procedures. It is not a promise of a cure.

The chosen physician must perform the essential services personally. A deputy may take over parts that can be delegated. If the named chosen physician is not available, the hospital must inform you. You can then do without the optional service for this procedure or agree to a deputy.

You can sign the optional services agreement during the first days of the stay, and it applies from the date of signing. It does not apply retroactively to services already provided, such as an emergency operation on the first night.

This is a trade-off between premium and the right to join. If you want to add the clause later, you go through new health questions. Many people therefore choose this component early, while acceptance is easy, even though statistically they tend to use it later.