Psychotherapy practitioner and health insurance: understand and optimise your path to reimbursement
14.05.25
8
Minutes
Katrin Straub
Managing Director at nextsure
Mental stress often requires prompt help, yet whether health insurance covers treatment from alternative practitioners specialising in psychotherapy raises many questions. This article outlines your options and shows you the concrete steps towards successful reimbursement.
The topic in brief and concise terms
Statutory health insurance funds only cover the costs of psychotherapy provided by non-medical practitioners in rare exceptional cases (§ 13(3) SGB V), often after proof of long waiting times of over three months.
Private health insurance policies and specific supplementary insurance policies offer significantly better chances of cost reimbursement, depending on the respective plan and contractual terms.
A careful review of your own insurance policy, thorough documentation and obtaining a certificate of medical necessity are crucial for a successful application for cost coverage.
Coverage by health insurers: understanding the basics
Statutory health insurance funds (GKV) generally do not cover the costs of psychotherapy provided by non-medical practitioners. There are only a few exceptional cases, for example in the event of a failure of the GKV system. Private health insurance (PKV) and supplementary insurance for non-medical practitioners often offer better chances. Reimbursement depends heavily on your individual policy. A careful review of your policy is therefore essential.
Quick Facts: Your options at a glance for GKV and PKV
Here are the key points regarding reimbursement of costs for naturopathic psychotherapy by the health insurance fund:
Statutory health insurance (GKV): Cost coverage is rare. In most cases, it is only possible under the reimbursement procedure pursuant to Section 13, paragraph 3 of the German Social Code, Book V. This requires proving unreasonable waiting times of more than three months with contract therapists.
Private health insurance (PKV): The chances of reimbursement are significantly higher. Naturopathic practitioner services must be included in the tariff. Many tariffs cover psychotherapy by naturopathic practitioners.
Supplementary insurance: An outpatient supplementary insurance for naturopathic practitioners can cover costs for people with statutory insurance. Reimbursement often applies up to a certain annual maximum amount.
Subsidy: Civil servants can also receive partial reimbursement for naturopathic psychotherapy. The exact conditions vary depending on the subsidy regulations.
Knowing the exact conditions is the first step towards successful reimbursement of costs.
Practical section: How to successfully apply for reimbursement of costs
The path to cost coverage requires initiative and careful documentation. With statutory health insurance (GKV), you often need to provide evidence of at least three to five rejections from contracted therapists. Keep a detailed call log of your enquiries. A medical necessity certificate from the doctor supports your application. With private health insurance (PKV), check your policy carefully for coverage of services by non-medical practitioners in psychotherapy. Always submit invoices in full and on time. Many patients overlook that the application to the GKV must be submitted before therapy begins. An hourly fee for non-medical practitioners specialising in psychotherapy is often between 40 and 120 euros. Billing is usually carried out according to the schedule of fees for non-medical practitioners (GebüH). Some of its rates still date back to 1985.
Our expert tip: The right preparation is crucial
Before starting treatment, clarify the reimbursement conditions with your health insurer. For private health insurance tariffs, have reimbursement confirmed in writing. With statutory health insurance, a preliminary discussion with the insurer about the required evidence can help clarify matters. Document every step, from phone calls to medical certificates. Careful documentation increases your chances of success many times over. Also remember that therapy costs paid out of pocket may be tax-deductible. They are classified as extraordinary expenses. This can mean financial relief of several hundred euros per year. Find out about private health insurance if you would like to use alternative therapies more often.
Expert depth: Legal foundations and current rulings
The Social Code (SGB V) governs the benefits of statutory health insurance (GKV). Section 13(3) of SGB V is central here for reimbursement of costs in exceptional cases. The Federal Social Court (BSG) has repeatedly confirmed that alternative practitioners are not regular providers under the GKV. One example is the judgment ref. no. B 1 KR 4/16 R. For policyholders with private insurance, the Insurance Contract Act (VVG) and the individual tariff are decisive. A judgment of the Dortmund Local Court (ref. no. 405 C 1913/11) strengthened alternative practitioners specialising in psychotherapy. It clarified that they belong to the professional group of alternative practitioners. They are therefore entitled to bill if the contract does not exclude them. The case law is constantly evolving. A precise understanding is advantageous for policyholders. The Schedule of Fees for Alternative Practitioners (GebüH) from 1985 is often used as the basis for billing. However, its rates are considered outdated. A supplementary health insurance policy can fill an important gap here.
Advantages as a self-pay patient and when it’s worth it
As a self-funder, you enjoy several advantages with psychotherapy from a non-medical practitioner. You avoid long waiting times and bureaucratic application procedures. In many cases, you can get an appointment within just a few days. The duration and frequency of therapy can be arranged flexibly. One important aspect: your diagnosis is not recorded with the health insurer. This can be advantageous when taking out insurance later on. For example, disability income insurance. Risk surcharges or rejections can thus be avoided. In the long term, this discretion can mean financial benefits of more than a thousand euros. Weigh the costs of around 60 to 120 euros per session against these benefits.
For those with statutory health insurance, supplementary insurance for alternative practitioner services is often worthwhile. These often cover a large proportion of the costs for psychotherapy provided by alternative practitioners. Reimbursement rates are often around eighty per cent of the invoice amount. Pay attention to annual maximum limits, which are often around one thousand euros. Compare offers carefully, as the benefits can vary considerably. Good health insurance should be flexible. A suitable supplementary policy can reduce the financial burden by up to eighty per cent. This gives you access to faster and more personalised therapy.
The path to your tailored solution with nextsure
Insurance cover for psychotherapy by alternative practitioners is a complex subject. nextsure is your partner for niche insurance and tailored cover solutions. We help you gain clarity. We analyse your situation and find the right solution. Our expertise in insurance law supports you. Use our digital platform for tailored protection. We offer a free review of your insurance situation. This can save you up to thirty per cent on premiums.
Request an individual risk analysis now: Have your insurance situation reviewed free of charge and receive specific optimisation suggestions.
More useful links
The Federal Ministry of Health provides comprehensive information on the field of alternative practitioners in Germany.
The Federal Ministry of Health provides guidance for aspiring alternative practitioners.
The Federal Statistical Office (Destatis) publishes press releases that may also include relevant health data.
The Federal Statistical Office (Destatis) offers detailed tables with key figures on doctors and related health sectors.
The GKV-Spitzenverband provides information on psychotherapy in the context of statutory health insurance.
The GKV-Spitzenverband gives recommendations on the approval of remedies within statutory health insurance.
The Association of Private Health Insurance (PKV) provides insights into benefits and reimbursement arrangements of private health insurance providers.
The Association of Independent Psychotherapists, Alternative Practitioners for Psychotherapy and Psychological Counsellors e.V. is the professional association for independent psychotherapists and alternative practitioners for psychotherapy.
The German Association of Alternative Practitioners represents the interests of alternative practitioners in Germany and provides information on their areas of practice.
FAQ
What is the difference between a psychotherapist and a non-medical practitioner for psychotherapy in terms of health insurance coverage?
Licensed psychotherapists (doctors or psychologists with a statutory health insurance licence) can bill the statutory health insurers directly. Alternative practitioners for psychotherapy are usually not reimbursable under statutory health insurance, except in narrow exceptional cases. Those with private insurance often have benefits with both, depending on their tariff.
Can I deduct the costs of psychotherapy from a natural health practitioner from my taxes?
Yes, medical expenses paid out of pocket, including psychotherapeutic treatments provided by a practitioner of alternative medicine, can be claimed as exceptional expenses in your tax return under certain conditions.
Is supplementary insurance for alternative practitioner services worth it?
For those insured under the statutory health insurance system who would like to make use of alternative treatment methods or psychotherapy from alternative practitioners, supplementary insurance can be worthwhile. It often covers a large share of the costs up to an annual maximum limit.
What role does the fee schedule for alternative practitioners (GebüH) play?
The GebüH serves as a guide for naturopaths when invoicing and is used by many private health insurers and subsidy offices as the basis for reimbursement. However, the rates contained therein date from 1985 and are often no longer cost-covering.
What does "system failure" mean in the context of GKV cost reimbursement?
System failure occurs when the statutory health insurance fund cannot arrange you an appointment with a licensed psychotherapist within a reasonable period (often three months), even though there is a medical need. In such cases, you may under certain circumstances be reimbursed for the costs of a service you have arranged yourself, e.g. from a non-medical practitioner for psychotherapy, in accordance with Section 13(3) of SGB V.
Do I need to inform my health insurance provider before starting therapy with a non-medical practitioner?
Yes, in particular if you are seeking reimbursement through the GKV, you must submit the application before the start of therapy. Even with private insurance or supplementary insurance, it is advisable to clarify cost coverage in advance to avoid surprises.
