Physiotherapy in private health insurance: exercise therapy and manual therapy

The process is always the same. The doctor prescribes after a diagnosis, the physiotherapist treats you and issues a private bill, and the insurer reimburses according to the plan. Most plans do not require approval before therapy starts. Typical reasons range from back complaints and aftercare following operations to the treatment of chronic joint diseases.

Physiotherapists are not bound by a state fee schedule and set their private prices themselves. The ranges in the table are guide values. In large cities, prices tend to be at the upper end.

The most common out-of-pocket share in physiotherapy does not come from missing cover but from the maximum rate clause. The plan reimburses a fixed amount per treatment for the prescribed therapeutic remedy, the practice charges more, and the patient pays the difference. For a single series these are manageable amounts. With chronic needs over years, they add up to a noticeable sum.

High-performance plans instead reimburse at the customary local or an appropriate level, or state generous rates. If you need physiotherapy regularly, give this clause more weight in the plan comparison than some more prominent components. In an existing contract, it helps to compare the practice price, the plan rate and the difference per series.

From more than 5,000 applications with health questions, we see physiotherapy from two angles. It is the most common therapeutic remedy item in existing contracts and a routine topic in the health questions. Prescribed series for back complaints are among the most common answers of all. Depending on the reason and the course, insurers rate them anywhere from unproblematic to subject to a surcharge. Clean documentation that the treatment has been completed helps with every later application.

We recommend that you obtain a confirmation of cover before longer series of treatment and submit bills collected per prescription series. We also recommend that you check the plan specifically for maximum rates and annual limits if you have chronic needs. This is where good clauses for therapeutic remedies separate from mediocre ones.

Yes, the prescription is the basis of every reimbursement. The doctor issues follow-up prescriptions if further therapy is medically justified. The plan does not reimburse treatment without a valid prescription.

After accidents at work and for occupational diseases, the statutory accident insurance is the primary payer, not private health insurance. The practice then bills the employers' liability insurance association directly. For private accidents, the normal reimbursement process applies.

That is prevention, not medical treatment. Some plans pay a subsidy toward courses, most do not. Exercise therapy prescribed for existing complaints is separate from this and is reimbursable as normal.