Heilpraktiker Psychotherapy and Health Insurance: Understanding and Optimising Your Path to Cost Reimbursement
14 May 2025
4
Minutes
Katrin Straub
CEO at nextsure
Psychological stress often requires quick help, but the coverage by health insurance for psychological therapists raises many questions. This article highlights your options and outlines specific steps for successful cost reimbursement.
The topic in brief and concise terms
Statutory health insurance funds only cover the costs for psychotherapy by alternative practitioners in rare exceptional cases (§ 13 para. 3 SGB V), often after proof of long waiting times of over three months.
Private health insurance and specific supplementary insurance offer significantly better chances of reimbursement, depending on the respective tariff and contract conditions.
A thorough review of your own insurance policy, careful documentation, and obtaining a certificate of necessity are crucial for a successful cost reimbursement application.
Understanding Health Insurance Coverage: The Basics
Statutory health insurance (GKV) generally does not cover costs for alternative practitioners' psychotherapy. There are only a few exceptions, such as in cases of system failure of the GKV. Private health insurance (PKV) and additional insurance for alternative practitioners often offer better prospects. The reimbursement largely depends on your individual contract. Therefore, a thorough review of your policy is essential.
Quick Facts: Your options with GKV and PKV at a glance
Here are the key points regarding insurance coverage for psychotherapist services by a Heilpraktiker:
Statutory Health Insurance (GKV): Coverage is rare. Usually, it is only possible through the reimbursement procedure according to Section 13, Paragraph 3 of SGB V. For this, unreasonable waiting times of more than three months with contracted therapists must be proven.
Private Health Insurance (PKV): The chances of reimbursement are significantly higher. Services provided by a Heilpraktiker must be included in the policy. Many policies cover psychotherapy by Heilpraktiker.
Supplementary Insurance: An outpatient Heilpraktiker supplementary insurance can cover costs for those with statutory insurance. Reimbursement often occurs up to a certain annual maximum rate.
Allowance (Beihilfe): Civil servants can also receive partial reimbursement for psychotherapy by a Heilpraktiker. The exact conditions vary according to the allowance regulations.
Knowing the exact conditions is the first step towards successful cost reimbursement.
Practical Part: How to Successfully Apply for Reimbursement
The path to obtaining coverage requires initiative and precise documentation. For statutory health insurance, you often need to provide evidence of at least three to five refusals from contract therapists. Keep a detailed log of your calls. A medical necessity certificate from your doctor supports your application. For private health insurance, carefully check your policy for coverage of alternative practitioner services in the field of psychotherapy. Always submit invoices completely and on time. Many patients overlook that the application with statutory health insurance must be submitted before therapy begins. An hourly rate for alternative practitioners in psychotherapy often ranges between 40 and 120 Euros. Billing is usually carried out according to the Fee Schedule for Alternative Practitioners (GebüH), with rates partially dating back to 1985.
Our expert tip: Proper preparation is crucial
Before starting therapy, clarify the terms of cost coverage with your health insurance company. For private health insurance, obtain written confirmation of cost coverage. With statutory health insurance, a preliminary discussion with the insurer about the necessary proofs can provide clarity. Document every step, from phone calls to medical certificates. Careful documentation significantly increases your chances of success. Also, remember that therapy costs you pay out of pocket may be tax deductible. They are considered extraordinary expenses. This can mean financial relief of up to several hundred euros per year. Inform yourself about private health insurance if you want to use alternative healing methods more frequently.
Expert Depth: Legal Foundations and Recent Judgments
The Social Security Code (SGB V) regulates the benefits of the statutory health insurance. § 13, paragraph three of SGB V is central here for cost reimbursement in exceptional cases. The Federal Social Court (BSG) repeatedly confirmed that alternative practitioners are not regular service providers for statutory health insurance. An example is the ruling Az.: B 1 KR 4/16 R. For privately insured individuals, the Insurance Contract Act (VVG) and the individual tariff are decisive. A ruling by the District Court of Dortmund (Az: 405 C 1913/11) strengthened alternative practitioners for psychotherapy. It clarified that they belong to the professional group of alternative practitioners. Thus, they are entitled to bill if the contract does not exclude them. The case law is constantly evolving. A precise understanding is advantageous for insured individuals. The fee schedule for alternative practitioners (GebüH) from 1985 often serves as a basis for billing. However, its rates are considered outdated. A supplementary health insurance can fill an important gap here.
Benefits of paying out of pocket and when it is worthwhile
As a self-paying patient, you enjoy several advantages with alternative practitioner psychotherapy. You bypass long waiting periods and bureaucratic application processes. Often, appointments are available within a few days. The duration and frequency of therapy can be arranged flexibly. An important aspect: your diagnosis is not recorded with the health insurance company. This can be advantageous when taking out insurance later, such as a disability insurance policy. Risk surcharges or rejections can thus be avoided. Maintaining confidentiality can mean long-term financial benefits of over a thousand euros. Weigh the cost of about 60 to 120 euros per session against these benefits.
Supplementary insurance as a sensible addition
For those with statutory health insurance, additional insurance for alternative practitioner services can often be valuable. These often cover a large portion of the costs for alternative psychotherapy. Reimbursement rates are often at eighty percent of the invoice amount. Pay attention to annual limits, which are often around one thousand euros. Compare the offers closely, as the services can vary greatly. A good health insurance should be flexible. An appropriate supplemental insurance can reduce the financial burden by up to eighty percent. This enables you to access faster and more individualised therapy.
The path to your bespoke solution with nextsure
More useful links
The Federal Ministry of Health offers comprehensive information about the naturopathy profession in Germany.
The Federal Ministry of Health provides guidelines for aspiring naturopaths.
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 areas.
The National Association of Statutory Health Insurance Funds provides information on psychotherapy in the context of statutory health insurance.
The National Association of Statutory Health Insurance Funds gives recommendations on the approval of remedies within the framework of statutory health insurance.
The Association of Private Health Insurance (PKV) offers insights into the benefits and reimbursement modalities of private health insurance.
The Association of Independent Psychotherapists, Naturopaths for Psychotherapy, and Psychological Counsellors e.V. is the professional representation for independent psychotherapists and naturopaths for psychotherapy.
The Association of German Naturopaths represents the interests of naturopaths in Germany and provides information about their fields of activity.
FAQ
What is the difference between a psychotherapist and a naturopath for psychotherapy in terms of health insurance coverage?
Approved psychotherapists (doctors or psychologists with health insurance affiliation) can directly bill statutory health insurance companies. Psychotherapy practitioners, on the other hand, are usually not eligible for reimbursement by statutory health insurance, except in rare cases. Private insured individuals often have entitlements to services for both, depending on the tariff.
Can I deduct the costs for psychotherapy from a non-medical practitioner from my taxes?
Yes, even personally incurred medical expenses, which may include psychotherapeutic treatments with an alternative practitioner, can be claimed as exceptional burdens in the tax return under certain conditions.
Is it worth getting supplementary insurance for naturopathic treatments?
For those with statutory insurance who wish to use alternative healing methods or psychotherapy through alternative practitioners, supplementary insurance can be beneficial. It often covers a large portion 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 alternative practitioners for invoicing and is used by many private health insurers and aid offices as a basis for reimbursement. However, the rates contained therein date back to 1985 and are often no longer cost-effective.
What does "system failure" mean in the context of GKV cost reimbursement?
A system failure occurs when the statutory health insurance cannot provide you with an appointment with an approved psychotherapist within a reasonable period (often three months), despite medical necessity. In such cases, you may be able to have the costs for services you arrange yourself, e.g., with a non-medical practitioner for psychotherapy, reimbursed (§ 13 para. 3 SGB V).
Do I need to inform my health insurance company before starting therapy with a naturopath?
Yes, especially if you are seeking cost coverage from the statutory health insurance (GKV), you must submit the application before starting therapy. Even with private insurance or supplementary insurance, it is advisable to clarify cost coverage in advance to avoid any surprises.
