Optional hospital services: types, legal framework and sensible choices

Every licensed hospital owes the general hospital services. These are accommodation, nursing care and treatment by the doctors on duty. Everything beyond that is an optional service and is agreed and billed separately.

Such extras can only be billed if they meet recognized medical standards. The details of the individual components, meaning chosen physician, choice of room and the hospital daily allowance as an alternative, are covered in separate articles. This page sets out the common framework.

The Hospital Remuneration Act sets tight formal limits on billing. Under § 17 KHEntgG, optional services must be agreed in writing before they are provided, and the hospital must inform the patient in advance about the charges and the content of the services. The prices must not be out of proportion to the service.

The agreement on chosen physician services has a reach that surprises many patients. It extends to all hospital doctors involved in the treatment who have the right to bill their services separately, including services by external doctors and facilities that they arrange. With one signature, you do not only buy the chief physician but the whole chain of chosen physicians, right down to the laboratory.

Formal errors are at the hospital's expense. If the agreement is not in writing or was only signed after treatment started, it is invalid and the surcharge for optional services does not have to be paid. It is therefore worth checking the date and signature of the agreement afterwards too.

Whether private health insurance reimburses the agreed optional services is not set out in the Hospital Remuneration Act but in the plan conditions. Comfort plans regularly include chosen physician services and a single or two-bed room, while entry-level plans are often limited to the general hospital services. If you deliberately do not use insured optional services, some plans pay a hospital daily allowance as compensation.

Before planned stays, a double check makes sense. First come the plan conditions, then the insurer's written confirmation of cover for the specific stay. This way the hospital's optional services agreement and your insurance cover match exactly, and no uncovered surcharge is left over.

People with statutory health insurance are entitled to the standard benefits. Optional services are open to them, but as self-payers. They can sign the agreement with the hospital just like privately insured people, but they pay the bill themselves. Access without the full cost risk comes from supplementary hospital insurance, which covers chosen physician and room category like a private full-cover plan.

In our advice work, we see that supplementary hospital insurance is the first contact with private benefits for many people with statutory insurance. We recommend taking it out in healthy years, because health questions apply here too, and pre-existing conditions lead to surcharges or exclusions.

No. Using them is voluntary, and doing without them can even pay off. Some plans then pay a hospital daily allowance as a flat compensation per day of the stay. If you do without the chosen physician, the doctor on duty treats you under the general hospital services.

Yes, you can cancel it at any time during the stay with effect for the future. Optional services already provided must still be paid. It is important to cancel in text form to the hospital, so that the date is documented.

Only to a limited extent. Purely private hospitals without a license do not bill under the Hospital Remuneration Act. Their fees are agreed freely. Whether a plan includes treatment in private hospitals, and up to what amount, is set out in the plan conditions, often with separate clauses.