This article will help you to understand the most common reasons for non/partial reimbursement of your medical costs. Some of the advice is specific to Feather customers but most of it applies to all types of private health insurance.
REASON 1
Your plan does not cover the item
This differs depending on the type of plan that you signed up for. For example, our standard short-term plan does not cover preventive measures.
REASON 2
The reimbursed amount is covered by your monthly bonus
If you have opted for long-term private insurance coverage with a €0 deductible, a monthly bonus is automatically paid to your bank account. You are expected to pay your medical bills from this yearly bonus pool. You will receive a reimbursement only when you submit enough claims to exceed your year's bonus. You can read more about how your bonus works here.
REASON 3
You did not get a referral from your general practitioner (Hausarzt)
Under our standard plans (short- and long-term), you will only be reimbursed 75% of the specialist bills when you see a specialist without a referral note from your general practitioner. To get full reimbursement, we advise that you get a referral before seeing a specialist.
REASON 4
The treatment/medication is not medically necessary
Private health insurance generally offers comprehensive coverage and a higher level of service than public health insurance. However, knowing that it is intended to help you pay for medically necessary treatments is important.
What is not medically necessary?
A remedy which is not referred to or prescribed by a medical doctor
Prescriptions that are not classed as medication, i.e. contraceptive measures, supplements, skin care, hair growth products
Vaccinations not recommended by the Standing Commission on Vaccination at the Robert Koch Institute (STIKO)
Travel/work-related vaccinations
Full body check ups for preventive purposes that are not recommended by the German government
REASON 5
The invoice does not provide enough information
Regardless of the treatment, a medical invoice must
Specify the diagnosis (e.g. what you had the treatment for)
The service number associated with the treatment is equivalent to the fee schedule for doctors (GOÄ) and dentists (GOZ)
Description of the services with the cost amount
If a medical professional charges you above the severity factor (Steigerungsfaktor) of 3,5 for a given treatment or assessment, then, by law, they are required to provide the justification in the invoice and/or provide you with a written statement to explain the reason for the overcharging. If this did not happen, you can ask your practice/clinic to re-issue an invoice which meets these formal criteria.
REASON 6
Your therapist charges you more than the amount that is covered by your insurance
There are no uniform price lists for remedies such as physiotherapy and ergotherapy. If your therapist charges you more than the amount stated in your coverage document, you will only be reimbursed up to the maximum amount stated in your coverage document. To determine whether your private health insurance will cover a remedy and how much of it will be covered, we suggest you submit a cost plan via your Feather account. The insurance provider will then assess your coverage according to your tariff.
REASON 7
You have exceeded your annual limit
Depending on your chosen plan, there could be a coverage limit for certain treatments/therapies.