Claim submission in private health insurance: how to submit bills correctly

The bill itself must contain certain minimum details so that the insurer can process it. These include:

• The patient's name.
• The date of treatment.
• The diagnosis, if the insurer asks for it.
• The GOÄ item numbers of the services provided.
• The fee factor applied.

If these details are missing, the insurer can send the bill back or ask you to provide them later.

The insurer checks whether the submitted service is reimbursable under the insurance conditions. For disputed or expensive treatment, it can ask for a medical statement or an assessment by a medical examiner it trusts. For routine bills this is the exception, but for long-term therapies such as psychotherapy or plannable operations it is not unusual.

Any agreed deductible is subtracted from the reimbursable amount. The insurer transfers the difference directly to the policyholder's account.

Before expensive dentures, longer psychotherapy or plannable operations, a confirmation of cover makes sense. The insurer confirms in advance that it will reimburse the treatment and to what extent. A confirmation of cover is not a claim. It is an advance approval, and the claim follows after the treatment is completed.

We recommend that you always submit claims with a copy of the original bill and, for plannable expensive treatment, with a confirmation of cover obtained from the insurer in advance.

With most insurers, by app or online portal in a few minutes. Photograph the bill, upload it, done. Paper is the exception. We also offer to handle the complete processing of your benefits and bills for you.