Avoiding dreadful doctor bills

18 posts in this topic

Posted

Hello there,

 

so here's the deal, I went to a gynaecologist, asked the same kind of usual general questions I did back home, got the same disagreeable-but-absolutely-notwendig exam I also got every second year at home... and was billed over € 300 for all that!

 

I have no idea what all the little lines on the bill mean (I mean, I understand the words, but I can't see where it comes from)! Of course I paid up wisely (having made a thorough search and found other threads recommending to do so), but I would really like to avoid that in the future. For stupid reasons my company forces me to be insured in France, and I am reimbursed based on health costs in France, where there is a fixed charge for every consultation (including any questions you might want to ask). In that case I have over 200 bucks to pay for some very general advice I could have found on Internet fora (if that's not what is billed, then really I don't get it).

 

Are we supposed to ask a question, ask the doctor how much it will cost him to reply it, and then if it's acceptable, tell him "then go along, answer it"? and when HE asks a question, are we supposed to ask him how much it costs if WE reply?

I know these questions may sound like ironic questions of someone who's angry, and that's partially the case, but above all I would like some honest advice for the future. I'm sure there must be a solution, because not everyone is privileged enough to pay this sum without having worries over rent payment.

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Posted

 

Your problem is not with the doctors but with your employer.

You seem to be under-insured, but I don't see the doctors are to blame, they'll bill the insurance or you, whoever is handy.

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Posted

this is quite rubbish, especially as you mention in previous posts you would like to get pregnant, that's when bills really start to roll in.

any chance of talking to your employer to get you a German insurance?

you had also previously mentioned you were not happy in your job, perhaps it is time to seriously look for a new one?

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Posted

Hello,

 

as always, amazed by how quick and helpful the answers are... [and feeling guilty that I have not yet reached the point where I can give some of it back]

 

It is my firm's standard practice to have all seconded employees insured in France (and Starshollow, I inquired, French "Caisse des Français de l'étranger" is apparently recognized in Germany. So they claim at least. I also use this thread to thank you for C R & Cie's excellent advice for all other insurances we subscribed through your firm in March or April). While this is indeed very nice for those who are sent to countries where public health systems are, say, underdeveloped, I don't quite see the point for developed countries. I could get insured extra in Germany, and in the end it's probably what I'll do, but I hate paying another 300 € a month when I'm already coughing up 700 in France for the same purpose! Plus it's also stupid for my firm who'd have to pay double their share.

I'm indeed moving jobs, within the same company (used your advice on that other post and decided it was no use fighting a lost fight), so I suppose I shall try to throw that in as well.

 

Although I must say, that I find the whole system rather shocking: basically practitioners seem to be free to rip off privately insured patients, which automatically drives costs up for everyone, and it's public knowledge - or what have I missed?

But I'm the intruder here, and it's for me to adapt.

 

The question remains, however: if I understand correctly most privately insured patients have some kind of franchise they must pay themselves (an average € 350) - do these people not try to limit costs at least as long as they're in the "Kasko" range? and how about the private insurers, how come they don't try to limit the abuse?

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Posted

I don't quite get how you can be an employee here in Germany and not automaticly be covered by healthcare, unless you're freelance.

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Posted

Don't know if it will help, but here's a list of the different charges you get for the various tests etc. (Gebührenordnung für Ärzte, GOÄ):

http://www.e-bis.de/goae/defaultFrame.htm

The easiest way to search is using the code number index (Ziffernindex).

 

Basically, as soon as you chat for more than 10 minutes on the phone or in person you get a higher charge for "detailed" advice, for instance.

 

In the past I have been charged for things they did not do (testing samples I did not give them), and when I pointed it out I got a new invoice.

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Posted

I think that Starshollow's point was that if you really are legally seconded from France working in Germany and covered under French insurance then you access healthcare through the German system. In essence you are treated (and charged) as if you were in the German system and the Germans charge back to the French.

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Posted

I don't understand why you simply didn't show your blue EU health insurance card -- you must have one if you are insured in the French system -- and then everything would have run through the system automatically --- ?

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Posted

The EU health insurance cards are valid for VISITORS not permanent residents. I am guessing she does not have one. I think after 6 months you are classed as permanent. How does the OP justify to the German Finanzamt or indeed the French authorities why she is paying social contributions in France while being resident in Germany? Would not like to be in her shoes when she does her tax declaration. How long is the OP seconded for? Who reimburses the medical bills? Your company or the French "caisse medicale"?

 

Concerning private patients contribution to medical treatment in Germany this is usually limited to paying part of the the cost of medicines, dental care and glasses and sometimes a cut of hospital stays - the bit that is regarded as hotel costs as separate from treatment! Insurance companies are aware of abuse but are obviously not that successful at capping it. German medical bills are eye-watering compared to what you pay in France which is the other extreme - like how do dentists or GPs make a living when they can only bill you peanuts? Seems to me you can add a zero to any dental care you receive in Germany compared to what you pay in France.

 

Just for further information, I also once did the annual gyno visit, had the standard procedure plus a few knobs, she also did extended ultra-sound breast examination in one session that should have been done over two and put two dates on the bill - so was obviously abusing the system - and it came to about 1500 Euros. Luckily I was privately insured. Which is maybe why it was so much. Forewarned is forearmed.

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Posted

At the 'Caisse des Français de l'étranger', you can also subscribe to a 'mutuelle' in France to top up the thin reimbursement. Of course, no all the nutuelle accepts since you are not living in France and it comes at a cost.

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Posted

I actually also have a "mutuelle" (included in those 700 € mentioned), which is very generous by French standards, i.e. reimburses up to 80 € per visit to a specialist. Even in Paris 95% of French doctors remain within these bounds. I must say I had no idea it would be exceeded in Germany, even after reading this forum for months before coming.

 

@ featherlight: I pay everything I have to in Germany, including income tax, Kirchensteuer (my choice), Rentenversicherung etc. My firm, as part of their secondment practice, compels me to pay social contributions extra in France, which is why I at least wanted to skip the health insurance part in Germany, as it does not go to the State anyway. [And I would not worry about French doctors too much: my eye specialist has a 200 m2 apartment next to the Pantheon with a stunning view. Not that she doesn't earn it, but she's hardly destitute]

 

@ anne k: thanks for the tip. I think at least one item on the bill is definitely an abuse.

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Posted

Private doctor and dentist insurance really does encourage rip-off situations. While investigating possible implant treatment a few years back I went to one dentist in Eberbach; saw him twice. Apart from a routine cleaning done by his assistant, he didn't do much beside poke around in my mouth on both occasions. I got a bill for over €736 for the pleasure.

 

On the bill was a series of minor items costing up to €40. The biggest item was €462. This was for:

 

Würzelglättung und Gingivalkurettage

Begründung: Subgigivale Konkrementenentferung, Würzelglättung, Gigivalkurettage sowie Zerstörung des Biolfilms als Akutbehandlung bei akutre Exacerbation.

Behandlung ohne Anäshesie

Starke Papille-, Sulkusblutung, Taschenspülung mit Chlorhexidinlösung; Wirkungsoptimierung durch Akrtivierung der bakterienreduzierenden Spüllösung mit piezoelektronischem Utlraschall.

 

I was nor aware of anything terribly complicated done to my gums. Certainly, nothing hurt and and I did not come away bleeding, nor did I spend much time on the dentist chair. And he didn't inform me of any major gum disease treatment.

This was in January 2009.

 

In February 2010 I hat a 2-hour Root Debridement by at an English dental surgery done. Now, that really was a treatment. It could never have been done without anesthesia --and I most certainly noticed. He dug deep into my roots and really cleaned everything out, . scraping away at plaque below the gum level so intensely you could hear it. I came away with bleeding gums and incredible pain once the anaesthetic had vanished. It cost GBP 800, but you know? It was worth it because I really felt something substantial had been done.

 

I believe the German dentist bill was bogus. He probably thought the insurance would pay it anyway so he could get away with it, and he did. In fact, the Beihilfe paid 70% and I paid the rest.

 

So yes, dentists and doctors do put things on private bills that don't belong there.

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Posted

 

here's a list of the different charges you get for the various tests etc. (Gebührenordnung für Ärzte, GOÄ):

http://www.e-bis.de/goae/defaultFrame.htm

 

For private patients doctors are allowed to charge up to 2.3 fold what the "GOÄ" stipulates (in special cases up to 3.5-fold). However, you can try to negotiate beforehand a lower multiple. Maybe worth a try even after having received the bill and explaining that you have to pay out of your own pocket. When I was a student my dentist (now retired) always told me to pay him only what the insurance would reimburse me, even if the bill was higher.

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Posted

 

The EU health insurance cards are valid for VISITORS not permanent residents.

 

There are exceptions. Permanent residents on bona fide secondment who fulfil certain criteria (and submit paperwork to confirm them) can access the German health system while continuing to be a member of the health service of their own country, for up to 2 years. They use their EHIC card in Germany whenever they need treatment.

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Posted

 

The EU health insurance cards are valid for VISITORS not permanent residents. I am guessing she does not have one. I think after 6 months you are classed as permanent. How does the OP justify to the German Finanzamt or indeed the French authorities why she is paying social contributions in France while being resident in Germany? Would not like to be in her shoes when she does her tax declaration. How long is the OP seconded for? Who reimburses the medical bills? Your company or the French "caisse medicale"?

 

Concerning private patients contribution to medical treatment in Germany this is usually limited to paying part of the the cost of medicines, dental care and glasses and sometimes a cut of hospital stays - the bit that is regarded as hotel costs as separate from treatment! Insurance companies are aware of abuse but are obviously not that successful at capping it. German medical bills are eye-watering compared to what you pay in France which is the other extreme - like how do dentists or GPs make a living when they can only bill you peanuts? Seems to me you can add a zero to any dental care you receive in Germany compared to what you pay in France.

 

Just for further information, I also once did the annual gyno visit, had the standard procedure plus a few knobs, she also did extended ultra-sound breast examination in one session that should have been done over two and put two dates on the bill - so was obviously abusing the system - and it came to about 1500 Euros. Luckily I was privately insured. Which is maybe why it was so much. Forewarned is forearmed.

 

In true secondment - which requires a certain process of application in France to be recognized etc. - an employee can live and work in another EU memberstate for up to 2 years (and in the end max. 5 years total) and continue to pay into the social welfare system of the country of origin while only paying taxes in Germany.

So, theoretically this is all ok and then the OP just needs to take the secondment papers to a local AOK for instance to get papers (pink, I think) for planned treatments in Germany (Behandlungsschein) which show the doctors/dentists that all charges on the level of normal public coverage in Germany are taken over by the AOK which will get then reimbursed by the French "Caisse".

 

Unfortunately, even with German citizen and normal public insurance clients, the IGEL system has made sure that doctors charge them extra on private levels and many doctors and their staff even take extra training to learn how to trick patients in saying "I want..." which already triggers a load of private charges then. Ripp off does not even cover what this is... legalized robbery is more like it....

 

 

I actually also have a "mutuelle" (included in those 700 € mentioned), which is very generous by French standards, i.e. reimburses up to 80 € per visit to a specialist. Even in Paris 95% of French doctors remain within these bounds. I must say I had no idea it would be exceeded in Germany, even after reading this forum for months before coming.

 

@ featherlight: I pay everything I have to in Germany, including income tax, Kirchensteuer (my choice), Rentenversicherung etc. My firm, as part of their secondment practice, compels me to pay social contributions extra in France, which is why I at least wanted to skip the health insurance part in Germany, as it does not go to the State anyway. [And I would not worry about French doctors too much: my eye specialist has a 200 m2 apartment next to the Pantheon with a stunning view. Not that she doesn't earn it, but she's hardly destitute]

 

@ anne k: thanks for the tip. I think at least one item on the bill is definitely an abuse.

 

Hyyo: tks for the kind words- glad we could be of help. What I do not understand, though from your above listing: if you are truly seconded, you should not pay into the German REntenversicherung. Only taxes (including church tax), yes - but no contributions for social welfare in Germany, not even unemployment insurance. Because legally as a seconded employee you remain outside the German welfare system. What you describe seems to be a very strange mix of things, which make me believe that your company is not actually using secondment as stipulated in the relevant EU laws. I would therefore advise that you ask HR specifically to show you the papers they filed on the French side for secondment...just to make sure that neither the company nor you end up in painfull situation with backcharges and penalties and what not...

 

Cheerio

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Posted

Yes, being reimbursed for treatment in Germany on the basis of what would be reimbursed in France sounds so unreal which is why I asked WHO is reimbursing her. Sounds like the company is trying to be clever at their employees expense. I could tell you a story about someone living in France but working for a German company who has no medical insurance or contributions in either country. He would love to change the situation but the company insists they cannot pay his contributions for some strange legal reason that no-one understands - oh really? - and he has been banging on their HR door for years.

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