Beware of the Doctor's 10 Euro rule

I am normally a healthy person able to manage my own care but recently discovered higher than average cholesterol levels as a result of a routine health check in the UK.

Out went the crisps and chocolate, substituted with a healthier option for 8 weeks before requesting a blood test to check the progress.

I knew that there would be a 10 euro charge per quarter for a visit to the local surgery, what I wasn't prepared for was the 20 euro charge. Why? My blood was drawn today therefore, 10euro for the first quarter. However, the results won't be available until Friday, which takes me into the second quarter, meaning a further 10 euros to pay; even if I only phone for the results!

Now I don't grudge the money but I do think the situation ludicrous.

I would grudge the money. You HAVE to have health insurance in this country. So they charge you twice.

It's not a double charge as such, the EUR 10 goes to the Krankenkasse, NOT the doctor. I've put off going to the doctirs in the last few weeks as I'll be going in Q2 anyway.

Longer term, even the Federal Government has said this charge won't last.

What we need of course to get public health on an even footing is for all the rich to stop opting out and make a standard % rate for EVERYONE! But only some of the Greens are in favour of that so far...

Unfortunately it's only in German but maybe you can read it .

http://www.die-gesundheitsreform.de/hinter...isgebuehren.pdf

On page 3 they say that you won't be charged a 2nd fee if the test of the blood sample can't be carried out in this quartal.

I had a similar problem last week. I went to one doctor, paid the €10, no problem. The next day I had to go to another doctor and she charged me another €10 even though I had the receipt from the previous day stating that I had already paid. She tried to explain why I had to pay again but her English wasn't very good and my German isn't very good, so to keep her happy I just paid. I still don't think I should have had to pay twice!

You have to pay up to 20,- Euros per quartal, 10,- Euros for visiting a any doctor and 10,- Euros for visiting a dentist.

Send copies of both receipts to your Krankenkasse and ask them to give you 10,- Euros back.

Careful!

Under the "good old system" you could refer yourself to any doctor you liked.

This suited the doctors who coined it it and basicly led to "health tourism" like my lazy bastard whinging ex who referred himself from doctor to doctor to always have an excuse not to get a job, but I digress...

Under the new €10 rule, you have to pay ONCE (& €10 for a dentist which is separate) IF you get yourself referred (Überweisung) from your standard doctor to another, say a specialist. The specialist may well ask to see the receipt.

IF you decide just to go straight to a specialist or simply another doctor WITHOUT a referral you HAVE to pay €10 AGAIN!

This has been fairly well explained to people, in German.

If you just went to another doctor without a "Überweisung" the €10 was correctly charged again and you won't get it back. If you DID have an Überweisung, get the money back from the krankenkasse as advised above by Karen.

every insurance with a deductible does that

the deductible on my health insurance was 500 bucks per year (as opposed to anywhere between 10 and 40 here, depending on how spread out over the year your doctor's visits are)

10 bucks is what you spend on a sandwich and a soda in any munich lunch place

so I would respectfully suggest: get over it...

I must say, agreeing with J (whoa) on this one, it does strike me as negligible. It is enough to make people thinks twice about going, but it's so little that it aint going to matter if you really need to go. Only peeve is that the doctors get out of the whole thing lightly. From experience I know that they are at least half the problem with the german health system.

I have a question about this if anyone knows the answer...

Scenario: Say I go to my Hausartz. Then, the next day I have an appointment with my Frauenartz. The next week (in the same quarter) I have an appointment with a specialist, as well as with my Zahnartz.

Would I be charged €30 total for all 4 appointments if I had an Überweisung for the specialist from my Hausartz? (€10 for the HA, €10 for the FA, €10 for the ZA and €0 for the specialist?)

OR do I not have to pay a separate fee for the Frauenartz? If I don't have to pay an extra fee for the FA, do I need an Überweisung from my Hausartz first?

Thanks for the clarification to this "what-if" scenario. I haven't quite got a grip on the whole thing just yet.

Man, some people get wrapped right up in this health industry dont they. I havent been to the doctor since I was like 9 and fell off my bike and mum took me along in case i needed stitches, which I didnt.

And heres people worrying about what happens if they have to visit 4 or 5 doctors in a week! No offence, but if your that messed up, you have bigger things to worry about than how much it costs, like maybe looking after yourself.

I realise its just a what-if scenario, but cmon... Surely needing health care is such a rare event that saving a few euros each time.. Well I know the locals like to stress about such things, I didnt expect it from Toytowners.

No wonder I pay so much in heath insurance.

Kza, didn't you ever hear of tempting fate? If karma exists then you will be a sick man in a few years.

I love that 'No offence, but...', it is usually followed by something comepletely offensive, as in this case.

Yes I fully expect that. I will probably end up like my granddad. He actually never went to hospital and only went to the doctor for the odd checkup all through his life, up until he turned about 75 and had a stroke.
But I can hardly force myself to have health problems now to avoid that can I.

Its ok in this case, its only commenting on a hypothetical situation, not on any actual real person.

You have to pay 10€ every quarter for visiting a doctor.

If you have to see a specialist, try always to get a referal from your normal doctor, then you are covered. Otherwise yes, you have to pay again. Which is why you have to pay it for the dentist, as they there is no referal for that.

Agree with the earlier post though, people in Germany just go from doctor to doctor and seems I know a few people that never use the same doctor twice, although since this charge, they have become a lot more loyal to one doctor.

@Chanda - if you piay the 10€ to the Hausarzt, you can then ask him to refer you to the Frauenarzt, and then you don't have to pay the 10€ there as well. You can in practice also avoid going to the Hausarzt altogether and pay your 10€ at the Frauenarzt for example and the Frauenarzt will write any referalls you need.

Thanks Karen, I think I understand it but I'll send it to Opa to clarify.

I never at any point actually seen a doctor. blood is taken on a Tues & Thurs, you can simply drop in and request what you like; as I did. The sample is drawn by the "artzhelferin"(glorified receptionist) and the only thing in contact with the doctor will be my blood in the lab. I intend to phone for the results, make my own decission re: treatment (unless dire emergency) and never be seen at the surgery again.

The money doesn't bother me but I think there will be a few old folks and such putting off a necessary visit to the surgery.

I agree and that is definitely unfortunate

on the other hand, I have never in any of the nine countries in which I have lived seen so many people consuming health care of all varieties (GP services, specialists, "krankengymnasten", medication, yadayada) with such reckless abandon

I used to work with perfectly healthy 30-year-olds making on average 2 doctor's visits a month. I personally have been to the doctor's 4 times since 1998 (I would have gone a fifth time but then the one time I needed a doctor in MUC they were all at the beer garden - see my post on this topic from late may '03)

and doctors are as much part of the problem as patients: SWMBO has a simple problem with her foot which has taken her 5 or 6 doctor's visits to achieve the result that I (as a non-doctor and having absolutely no clue of medicine whatsoever!) guessed on day 1: must take x-ray, see problem, presribe medication, resolve problem

so any measure that makes people stop and think before they go to the doctor's but that is not such that it will stop people really in need from seeking the care that they need is probably not a bad thing (and if you find a poor old lady who needs an operation to survive and really really can't afford the tenner, refer her to me and I will personally arrange the ueberweisung that same day. terms and conditions apply. always read the label.)

i have no qualms with the €10 rule. i was fit as a baby, then i came to germany and learned that if you don't call in sick once in awhile, people will think you're overly ambitious. seesm pretty stupid that starting at day 3, you need a dr's note. 2 days at home has always done it for me.

ladies watch out though if you take the pill. your dr. can only prescribe you your pills once every 3 months, meaning each quarter you have to go in to pick up a new prescription and also pay €10 each time (last time i checked, 3 months worth cost me €30). the exception is for those lucky 18-22 year-olds who can get a prescription for 6 months.

Its obvious that this new rule will drop health costs leading to lower Krankenkasse, and Krankenversicherung costs , and you will get the Euro 40 per year back this way.

The only loosers are the doctors who will have fewer trivial visits and earn less, and the abusers of the system.

It doesn't affect me anyway I have an ex-pat insurance that 1/4 the price. But I pay an excess of UKP25 per claim.

I don't think it will lower the Krankenversicherung price. As they introduced this charge, the Krankenversicherung actually went up.

The problem is, there are 12.5% unemployed, and the goverment need to raise funds to keep giving these people there unemployement benefit. I think it will soon be that they are grabbing money everywhere to keep this up.

@ Elfenstar: See my above mentioned link. Every woman will get a prescription for 6 month now.

My payments to the AOK have just dropped by EUR 46,56 a year so it's about even stevens even though of course it's a MASSIVE lessening of the load on industry who pay half the contributions and a greater proportionate burden on workers.

As someone mentioned above 3 days off work means a doctor note, plus if you are chronicly sick and need a regular prescription you HAVE to go to the doctor.

The € 10 charge (as well as increased prescription charges) IS a problem for those on low incomes. An elderly resident of a full time care home for example gets
€ 50 "pocket money" a month out of which they have to pay this charge.

The old old system (pre 1993 or so) was paper based and you got a book of tickets for the year and gave one every quarter to your doctor and they then then had to give you a referral to a specialist.

The introduction of the chipcards opened up direct access by patients to specialists and a merry-go-round of doctors visits that means for example that the health records of patients are much more disjointed than (say) in the UK with it's strong "gatekeeper" system.

Apparently, experts were warning that the chipcards were going to mean a massive cost explosion in Germany public health but the CDU/CSU and especially the FDP were all in favour of a "free market" in healthcare and of course the FDPs client base (well off docitrs etc ) were going to make a LOT of money...

thanks karen. shows just how quickly information changes. pays to stay informed. god bless TT (& Karen)!

@Kathie--

Thanks for the clarification and the tip, it's much appreciated!

What is so offensive about that , since I came here (18 months) , I've had two eye infections (Hotel Derah Max Emanuel does something shocking to their bed linen) like golf balls and broken my foot and all I did was walk into a hospital (well hobbled) and they stuck it in a cast and that was that! Oh yeh and I still came into work after the hospital you babies!
The body is pretty tough , why should young fit and healthy people who never go to the docs pay for unfit sick folks (particularly smokers)?
My German ex went to her gyno every month , dentist once a week and a regular doc once a month all while being a student , mostly the dentist and her talked about her earrings.
One thing the US does far better IMHO.

@Kza--

Thanks! (Please 'hear' my sarcasm in that) I appreciate (again, sarcasm) posting here asking for a legitimate clarification and having you attack me for trying to understand the new rules of the health care system. Especially being a new Toytowner, I just wanted to say thanks for making me feel so welcome (and just in case you didn't get it, again, sarcasm).


Excuse you? How dare you say something like that to me! Especially after I posted questioning a what-if scenario...and even if I didn't post as such and I really did need such care, who are you to judge my health vs. my lifestyle??

You owe me an apology.

Maybe you should think before you post such things in the future, or, if that's too taxing, reserve said postings for people you are more familiar with--who might appreciate your sass.


If you were quick enough to realize that it was a what-if scenario (when specifically stated as such), then you should have also realized that it was a request for clarification of the rules (as stated as such).

By the way, you don't know me. Perhaps I have cancer, or diabetes, or any other number of illnesses that would require such care. Thank God I do not suffer from any of these ailments, but just because your need for healthcare is "rare" doesn't mean everyone else's case reflects yours.

*end of defense*

@ anyone else reading--

Many of you have been very kind and have shared a wealth of information with me, for which I am grateful. I know that I am new here and many of you know each other already. I hope I haven't offended any of you with this post. I felt the need to defend myself because attacks such as Kza's are unwarranted.

Chanda

@ Chandra What attack? My post wasnt even directed at you. I was just jumping in with my opinion.

Noone. I dont even know you, or your health, or your lifestyle. How can I judge it? I was responding to the hypothetical situation as presented independant of any one individual.


What for? What did I do to you again? Last time I checked free speech was a right, and people were allowed to have opinions.

What are you rambling on about? My post wasnt "for" anyone specifically at all, I was just throwing in my 2c.


Fine. And other people did that. I on the other hand, chose to reply with an opinion instead. Just because you start a thread it doesnt make you the censor. Anyone is allowed to jump in and say whatever they like.


I know, thats why I havent said anything about you or judged you at all.

Just some advice buddy, if your really that sensitive that you interpret someones opinion as a personal attack when its nothing of the sort, then you arent going to enjoy taking part in online discussions very much! Also, I dont appreciate your confrontational tone, but I dont let it bother me, its just a internet forum, its not actually worth getting your knickers in a knot about. The great thing about the net is if you dont like something, simply ignore it!

Face it Kza ur a white male chauvinistic bastard

This topic is about COST of healthcare - plainly divorcing said costs from usage has resulted in incredible systematic abuse. So losers like me have to pay for others... and when we say sumthin we get the feminazi put down - beautiful...

(Man two good threads in two days he he )

Well I still dont know what sex or gender the other people in this thread are, and I dont really care.

But I have recieved a PM telling me that women (like smokers) have special needs that require more frequent visits to health professionals. News to me but fine, I can accept that. I can even accept subsidising it.

I just hope their insurance contributions reflect this.

I have not researched this but I seem to recall that there is an exemption for people on very low incomes so if that is true then there is no excuse left.

personally I would say that a €5 deductible per visit subject to a monthly or yearly maximum would be a better deterrent against frivolous use of the health system (and perhaps would make patients demand from their doctors that they be helped in one visit instead of 3 or 4 for any given health problem)

even when you do not pay your doctor gets paid by your insurer or kasse for each visit so they have an incentive to send you off with a half solution and make you come back. if it does not cost you anything you are likely to put up with this

anyway wishful thinking, doctor's lobbies and bleeding heart lefties will oppose any such measure (for now)

PS: regarding

my understanding is: yes if they are privately insured, no if they are kasse

Hope you all know that you don't need to pay anything if it is just a precaution examniation, like Frauenarzt or dentist.

In germany you have to go to the dentist at least once a year, to check if everything is alright. If you are just going for precaution examination and don't suffer from any problems you don't have to pay anything.

btw even your Hausarzt can give you a receipt for the bill, if that is the only reason you are going there for.

Jordigo, afaik, there are no reductions for those in the situation of living in elderly care homes for example.

Yes, the doctors lobby has had an interest in half-treating people and over treating people for a long time for their own financial gain and yes there should be amechanism to stop "health tourism" around several doctors surgeries for nothing.

Simplest way would be for everyone to have ONE "hausarzt" and get their referalls to all specialists through them.

Germany's social welfare system as a whole, not just health, has a lot of bias towards the well-off and the €10 flat fee is an example of that.

If wanting that EVERYONE has access to health and welfare services and that EVERYONE makes a fair share contribution towards it makes me a "lefty", then it's a label I'm proud to have!

Kza,
I remember this thread. For those whose memories are less good than mine, let me quote from it:

Are you really in a position to cast up what use other people make of the welfare state? You seem to believe so, others might not agree.
Katrina
PS I am privately insured, white, female and get my prescriptions from my Frauenarzt by post (a service which I am happy to pay for).

Is that a law or something? I've been here 2 years now and havn't been yet.

Glad I don't kiss you then. Urrrgggggg.
If you go to your dental check-ups regularly you can get a discount on your (gesetzliche) health insurance apparently.
Katrina

Sorry mate , being a lefty doesnt mean that you are excused from posting something devoid of all logic. The €10 fee is a FLAT fee , presumably those wealthy folks are too busy working their asses off generating more wealth to be clogging up their doctor's surgeries.

Fair share contribution ? Listen if you wanna come around to my place and make a "fair share contribution" to my bills , none of which you incurred then by all means PM me your address and I'll have em shipped over to you.

Funny how "fairness" does not equate to "equity" , should doctors and other health costs be free then I'm all for what you propose, until that day those who incur the costs should pay proportionately.

So Katrina, that's how it's going to be then Right, the gloves are off.

I have had 3 absolutely traumatic experiences in Dentists and only go when necessary. But yeah, I was planning to go soon (I reckon once a year is adequate), but now I have a reason. How are we going to do this Katrina? Where will I collect?

I'm getting on thin ice here as I am not sure, but I think if you have severe problems with your teeth which could have been solved much better, earlier and cheaper when going to the dentists check ups regularly, then the Krankenkasse might don't pay the full bill...

@Kza - what are your views on the availibility of health care in Palestine?

Think that someone else has a monopoly on thin ice today bubbly!
I hate the dentists too, I'm ok with them having a look but any needles...brrr! I had a filling done once on a wisdom tooth without anaesthetic (he drilled, I kicked, it wasn't good). So I get them to give me tranquilisers. Seriously.
2 pills in the waiting room, read a bit of Gala then it is all trees and flowers for me.
My dentist is in Frankfurt am Main (Dr Anke Isser, she teaches at Frankfurt Uni, is young, attractive and took all 4 of my wisdom teeth out in under an hour) unfortunately. There is apparently a good dentist at Sendlinger Tor, US-American guy, my mate went but she's on a plane to Kenya at the moment.
This lot next to the Goethe Insitute are meant to be great with nervous patients, I think that they only do private cases though.
So an extra big from me
Katrina

For Jimbo:

Well assuming your average unimportant guy on the street is allowed to have an opinion, then sure. If people want to know what I really think of the tax/welfare system, then I prefer a more minimal free-market based approach.

Still, it was hard for this political belief to interfere with my enjoyment of my tax payer funded holiday. As miserable and guilty as I wanted to feel, all that free time and free money just had an annoyingly positive affect on my mood.

Regarding the dentist, well I havent been for at least 5 years, and I know I need to go. I dunno if theres any open when I arent working though, have to look into it.

The reason i feel so reluctant to go to the doctor until its absolutley necessary is that where I come from theres huge waiting lists of people who really need health care. When some perfectly healthy person comes along chewing up a doctors time, its just making those waiting lists longer.

But there is no issue in taking benfit to which you are not entitled?
According to arbeitsagentur.de, the Arbeitsamt internet portal

Although I do not personally ski, I believe that it is not possible to ski and actively apply for employment at the same time. The skiiers on this forum will be able to say more on that topic.
Of course
, mind you he doesn't claim benefit without being entitled to it either (otherwise there would be a lot more than 4 million receiving unemployment benefit in Germany).
Misuse of public funds remains misuse of public funds, no matter which public funds are concerned.
Therefore your opinion on the misuse public funds is, like your claim for Arbeitslosengeld, invalid.
Katrina

@ Parnell

A FLAT rate means that it is more expensive for someone on a lower income.
They have to work longer / spend a proportionately bigger slice of their income on the €10 fee than someone richer.

A "fair" system would be everyone paying the same % of their income into the social "pot" and everyone having access to the same services.

As it happens right now, once you cross a threshold of about € 45K or so a year you can "opt out" of the kasse. It's a vicious circle as it means those still paying into the Kasse are a smaller net payer base to support the unemployed, very low paid or chronicly sick who the private insurers won't touch.

Not meant at you personally, but we all perhaps should think sometimes about other people in the city where we live rather than how we are coining it in in our fab lifestyles...

Wouldn't it be more efficient to pay rewards for people who don't go to the docotr instead of charging everyone 10 Euros? Once I need to see a doctor and paid my 10 Euros I would go to all the other doctors I've wnted to see , too, although I'm not seriously ill.

@ Kza: It's not healthy to work 24/7.

Uh, Elfenstar, why don't you do the obvious and go back before the end of the three months to save yourself 10 Euros?

you are obviously joking so should have posted a with this line

the "well off" (in this context: well above beitragsbemessungsgrenze) contribute less to social security as a proportion of their income but also are subject to all sorts of caps so get less back, e.g.

* the rule is you get a % of your income as a pension when you retire, but this is capped so the "the well off" get proportionally less
* arbeitslosengeld is meant to be a % of income but this too is capped
* the children of the "well off" do not get BAFOeG when they go to uni
* the "well off" do not get eigenheimzulage
* the "well off" do not get vermoegenswirksame leistungen
* the "well off" are unlikely to get arbeitslosenhilfe after their arbeitslosengeld runs out since you are only allowed to have net assets of 300 euros times years lived (I personally was a victim of this rule)

so the bottom line is: the well of contribute proportionally less but also get proportionally less. can live with that if I must...

the main favourable bias is not toward the "the well off" but to the ones at the "bottom of the pile":

* sozialhilfe is roughly the same as what you would get working in a menial job (what would be equivalent to a minimum wage job in the UK or US)
* those on very low incomes get health care at very low prices (since they pay a % of their low income)
* kindergeld is proportionally much larger compared to their incomes

the main losers are average middle class people. they are not above the beitragsbemessungsgrenze and so their social security contributions are proportionally highest in relation to what they get back

e.g. (simplified and excl arbeitgeberbeitraege)

person earns 1000 and pays 20% and gets 200 kindergeld --> net net he pays nil or 0% and the benefit is worth 25% of his income after contributions

person earns 2000 and pays 20% and gets 200 kindergeld --> net he pays 200 or 10% and the benefit is worth 12.5% of his income after contributions

person earns 6000 and pays 20% on BBG (say that is 5000) and gets 200 kindergeld --> net he pays 800 or 13.33% and the benefit is worth 4% of his income after contributions

person earns 10000 and pays 20% on BBG (say that is 5000) and gets 200 kindergeld --> net he pays 800 or 8% and the benefit is worth 2.2% of his income after contributions

as you see, main beneficiary in % terms is the very low earner. major sucker is the middle class / slightly better off group (the bulk of the population)

Jordigo, all those things that the well off miss out on are "peanuts", Vermögungswirksamerleistung is what , maximum € 30 a month?, how much is a yuppie in Grünwald saving by being privately health insured as to being in the AOK, a helluva lot more.

I do agree though that some of the biggest losers of the system are those on OK incomes who don't have the write-off possibilities of the mega rich. If I'm ever on the dole I'd personally fall into the same trap you did.

Anyway, back to work so I can pay 50% of my income in tax and social insurance!

No that wouldnt be fair at all , unless cheaper (in terms of cost) medical care could be made available to those contributing less. You are only looking at the demand side of the argument - and therefore ignoring half the story. My ex (who is German herself) thought it perfectly acceptable behaviour for her to go as often as she liked to the doc's surgery. She told me that it was absolutely common for most doctors practices to be full of old folks who were a bit bored or lonely at home.

It's total bullshit that a fit young person who has no need for extensive medical care should pay through the nose for others who feel that need. Hell , why don't we all be "fair" and extend our ridiculous medical care to other countries like India , at least in that case some of them might be grateful!

Simply put these things cost money and where cost is divorced from usage ridiculous inequities thrive , as in this case. I paid over €2500 last year for medical care for which I received nothing in return. I'm perfectly happy to help others out but I should not be FORCED to do such a thing.

In any case most people who have problems with €10 per quarter are very likely to be entirely dependent on welfare. Far more equitable would be to have a flat fee of 3x doctors fee for normal visit with a sliding scale of contributions for more serious issues.

huh showem? in one case i had a small surgery in january. moved to munich, had to visit another surgeon cause the previous work wasn't done quite right, was told to come back in 8 weeks--> next quarter. €30 later... my bad luck however. but yeah, since i need all new docs, am trying to squeeze in as many appt's this quarter as possible.