Affiliated physician: when your own doctor treats you in hospital

In the German hospital system, a doctor can work in different ways. The chief physician and the senior consultant are employees of the hospital. The affiliated physician, by contrast, is self-employed in private practice and has a contract with a hospital to use affiliated beds.

In concrete terms, this means the affiliated physician has their own practice and treats patients there as outpatients. If a case requires inpatient care, they move the patient to one of their affiliated beds in the partner hospital. The hospital provides the infrastructure, meaning nursing, operating room, laboratory and technology, while the affiliated physician provides the medical service. For privately insured people, the advantage is being treated by a doctor who knows their history and stays with the treatment from start to finish. There is no break between outpatient treatment beforehand and inpatient care by a doctor you do not know.

Billing runs on two tracks. The doctor issues a bill under the fee schedule for doctors, even if the treatment was inpatient. The hospital issues a separate bill for accommodation, nursing and technology. Privately insured people submit both bills to their insurer. If you submit only one of them, you receive only partial reimbursement.

The affiliated physician model is common in specialized fields. Ophthalmology, gynecology, ENT, orthopedics and surgery are typical areas. Here there are procedures that start as outpatient treatment and move to an inpatient setting if there are complications or an overnight stay is needed. A typical example is eye surgery: the patient arrives in the morning, has the operation, spends the night in an affiliated hospital bed and is discharged the next day, while aftercare continues in the familiar practice.

For private health insurance, what matters is how the plan defines the services of an affiliated physician. Some plans reimburse them like regular inpatient optional hospital services, others distinguish between affiliated physician and chief physician or set conditions. If you only find this out when you make a claim, you face unexpected costs of your own. Another common misunderstanding is to treat the affiliated physician as the same as the chief physician. The chief physician is a hospital employee, while the affiliated physician actively brings their own patients to the hospital. A pure chief physician clause therefore does not automatically cover their services.

The affiliated physician bills at the same fee factors as for outpatient private treatment. The standard value is 2.3 times the base rate, and up to 3.5 times is possible with a special justification. Private plans usually reimburse up to 3.5 times the rate, which is enough for procedures by an affiliated physician. Before a planned procedure with an affiliated physician, we recommend checking whether your plan expressly covers affiliated physician services under the fee schedule.