What Does The Health Insurance Company Pay For - A Doctor's Visit

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What Does The Health Insurance Company Pay For - A Doctor's Visit
What Does The Health Insurance Company Pay For - A Doctor's Visit
Video: What Does The Health Insurance Company Pay For - A Doctor's Visit
Video: This Doctor Won’t Take Health Insurance - and Charges Just $35 a Visit 2023, February
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Visit to the doctor: costs and deductibles

Every year the social security sends the so-called performance information for the insured (LIVE). This lists all the costs of those health insurance benefits that were used in the past year. This service is available as "LIVE-Online" on the social security homepage. There are no fees for using “LIVE-Online”, but you must register with your citizen card.

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  • Contract doctors
  • Elective doctors

Contract doctors

Contract doctors provide medical services within the framework of the contracts they have concluded with the health insurance provider. The services are billed directly between the doctors and the respective health insurance provider - so you as a patient do not pay anything for health insurance benefits in the health insurance office. However, some social security institutions charge a contribution to the costs (a deductible) for medical assistance.

There are medical services that are not paid for by health insurers. You can find out from your doctor or directly from your health insurance provider what your health insurance covers and what does not. Sometimes the following are not paid:

  • Services provided by private doctors
  • Medicines, if they are not included in the list of medicinal products of the umbrella organization of the Austrian social insurance,
  • medically unnecessary services (e.g. sports examination),
  • Confirmations for private insurance companies, private associations etc.,
  • Additional examinations for preventive examinations that are not included in the usual preventive medical check-ups,
  • Visits to a doctor of your choice if you also visited a contract doctor in the same specialist field in the same calendar quarter,
  • every visit to another doctor of your choice if you have previously visited a doctor of your choice in the same subject and in the same quarter.

Elective doctors

Elective doctors freely determine their fees. You are not bound to any given tariffs (there are sometimes recommended tariffs of the medical association that you can use as a guide) Patients pay the fee directly to the doctor and receive part of the costs from their health insurance provider. Insured persons who visit a doctor of their choice are entitled to reimbursement of those treatment costs - to the extent of 80 percent of the amount that their health insurance provider would pay a contract doctor in this case. The 20 percent is deducted for the increased administrative effort (processing, testing and instruction) compared to the contract doctor. However, there are also limited benefits from the insurers,for which you receive less than 80 percent.

The prerequisite for the assumption of the costs by the health insurance company is that you present the following documents and information:

  • the original fee note with

    • detailed information on the diagnosis and the individual medical services provided,
    • Your personal data or those of the co-insured persons (first and last name, date of birth, social security number),
    • Treatment date,
    • Date of issue of the invoice,
    • Invoice amount,
    • Signature and stamp of the doctor,
  • A confirmation that you have paid the amount (confirmation on the invoice, for example "Thank you received the amount", or a receipt, payment slip or bank statement),
  • Information about your bank details (account number and sort code) and your address for transferring the amount.

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