Elective Doctor Costs - Statutory Health Insurance Doctor - Private Doctor

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Elective Doctor Costs - Statutory Health Insurance Doctor - Private Doctor
Elective Doctor Costs - Statutory Health Insurance Doctor - Private Doctor

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Statutory, elective or private doctor?

Statutory, elective or private doctors do not only differ in terms of costs. In contrast to an elective doctor, the costs of a private doctor have to be borne entirely by yourself. In Austria there are different social security agencies that are also responsible for health insurance. The health insurance companies have contracts with doctors (contract doctors), on the basis of which the services of doctors in patient care are billed.

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  • Continue reading
  • more on the subject
  • Advice, downloads & tools
  • Free choice of medical doctors
  • Medical offers to be paid for yourself
  • Doctor's office opening times
  • Accessibility in medical practices
  • Further medical activities

Free choice of medical doctors

You have the right to choose your doctor freely. When it comes to costs and the type of billing, medical practices in Austria can be divided into three groups:

Checkout practices

Health insurance practices are run by so-called contract doctors: general practitioners, specialists who have a contract with a health insurance provider. Doctors provide contractually agreed services, the costs of which are covered by social insurance. With some insurance companies, patient co-payments (deductibles) are stipulated afterwards by social insurance. The social insurance contracts with doctors guarantee, for example, certain opening times for patients and that doctors prescribe examinations, therapies and medication in accordance with established medical and economic guidelines.

Elective medical practices

Elective medical practices are run by doctors without health insurance contracts. You can set your fees freely (if necessary, there are also recommendation fees from the Medical Association). Patients pay for medical services out of their own pocket. After submitting the invoice to the health insurance company, they will reimburse part of the costs (for more information, see Costs and deductibles) In addition to the amount of their fees, elective doctors can also freely choose the location of the ordination, their ordination times and their range of services. In order to avoid ambiguities or even nasty surprises, patients should clarify the cost issue with their doctor or the amount of the reimbursement with their health insurance provider before starting treatment.

Private practices

Private practices are run by doctors who are not entitled to reimbursement of costs - even if they are benefits as defined by the health insurance providers. You have a health insurance contract and also operate a "private ordination" (in the health insurance office or physically separate from it) or, although you meet the formal requirements of an elective doctor, do not break down your fee notes in terms of health insurance benefits. The fee structure in private practices is completely free and not tied to any upper or lower limit. The recommended tariffs of the medical associations in the federal states as well as the Austrian medical association (www.aerztekammer.at) can be used as a guide for whether a fee is appropriate.In any case, agree on the amount of the fee with your treating doctor before the start of treatment.

Medical offers to be paid for yourself

All services from the service catalog of a health insurance carrier are covered by the latter if they are used in a health insurance practice. In addition, doctors can also offer so-called non-contractual services and charge a private fee for this. However, you must explicitly inform the patient about this in advance. This also applies in the event that the patient himself / herself wants a diagnostic or treatment method that is not covered by statutory health insurance. In some medical practices, certain products such as cosmetics, contact lenses or dietary supplements are also offered for sale. As a consumer, you are free to decide whether you want to buy such goods or not. Price comparisons are also useful.

According to the Doctors Act, doctors are generally required to primarily use conventional medicine, i.e. scientifically recognized treatment methods. They can also offer complementary medical methods such as acupuncture, traditional Chinese medicine or homeopathy. The doctor is obliged to inform the patient if the proposed procedure is not scientifically recognized. Statutory health insurance does not cover the costs for this.

Tip Have the advantages and disadvantages of the method chosen by the doctor in comparison to conventional medical procedures explain to you in detail and weigh them carefully.

Doctor's office opening times

Contract doctors must adhere to the minimum coordination times specified by the respective health insurance provider. The number of hours varies depending on the state and is around 20 hours per week. These are to be divided into morning, afternoon and evening sessions.

Home visits are not included in these 20 hours, but are carried out in addition. Elective doctors do not have to comply with any guidelines with regard to their opening times.

Accessibility in medical practices

In 2005, the Austrian government laid down the goal of “eliminating or preventing discrimination against people with disabilities” in the Equal Opportunities for People with Disabilities Act, thereby guaranteeing them a self-determined and equal life in society.

According to the law, "structural systems, means of transport, technical objects of use, information processing systems and other designed areas of life are considered to be barrier-free if they are accessible and usable for people with disabilities in the usual way - without particular difficulty and generally without outside help". According to the Federal Disability Equality Act, disabled people can sue for structural measures.

Certain provisions on accessibility also apply to ordinations: for example, since July 1, 2006, doctors should consult an association for the disabled in order to achieve accessibility when setting up a new ordination or successor to ordination. Doctors are also required to inform patients about barriers before they visit the ordination. You can find barrier-free ordinations on the website of the Austrian Society for Quality Assurance and Quality Management in Medicine.

Further medical activities

Medical services that are not used for medical treatment must always be paid for privately. These include:

  • Driver's license examinations
  • Medical certificates for schools, employers, private insurances, etc.
  • Confirmations of care leave
  • Living wills
  • Vaccinations
  • Travel prophylaxis and travel vaccinations

Cosmetic treatments are only considered to be medical treatment if they serve to eliminate disease states.

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