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AOK health insurance

Info on what it covers exactly

Toytown Germany > Discussion forum > Germany-wide > Finance
apiapiaba
I'm wondering, if I have a health insurance from AOK, is that means that i could go to check my health with any doctor for free??
I'm planning to go to Doctor specialized in Ear,Nose and Throat Health. Can I use my AOK to go there?? How do I call Doctor fpr Ear, Nose and throat in gErmany?
mix_twix
I'm also insured with AOK through work. Went to the doctors for the first time a few weeks ago. Had to pay a €10 registration fee that (I was told) you have to pay every quarter. Ask for a receipt when you pay this as if you go to another doctor's surgery it's proof you've already paid the fee. Otherwise you'll have to pay again (so I'm told...).
William
The AOK covers almost anything you may need; go to any doctor, give them your card and they will see you.

On the €10 fee; that covers you for the quarter i.e. pay it in January and you are covered until the end of March, pay in December and you're only covered until the end of the year.
Also, there is a separate fee for each type of medical coverage, if you need to go to a dentist the €10 paid to your GP will not cover you, you have to pay a separate fee to the dentist.
maekelborger
If you're going for a preventitive check-up, immunisations, etc. (Vorsorgeuntersuchung) then you don't need to pay the €10 - this only applies if you want/need treatment, and in any case only applies to those that are state ("gesetzlich") insured (as the AOK insurance probably is)
apiapiaba
thanks for the information.
If the doctor give a medicine, do i need to pay for the medicine?
Mariposa
apiapiaba, that depends. Some medications are covered by insurance, some aren't. You will have to ask about that. (If you are seriously sick, it is almost certain that the medication is covered, such as antibiotics etc., things that are not covered are often flu medication, allergy medication, etc.) If it is covered, all you have to pay is Rezeptgebühr (unless you are exempt from it), which is usually around €5.

The quarterly fee of €10 (Praxisgebühr) you have to pay once, but once you've paid it you need a referral to every other doctor (or pay it again) from the one you paid it to, so if your specialist is out of your way, it might make more sense to go to your Hausarzt first (if it is closer to your house), and get a referral from them to a specialist (the HNO doctor you want to see). The €10 fee for the dentist goes separately, by the way.
eurovol
QUOTE (maekelborger @ Nov 30 2007, 10:49 am) *
If you're going for a preventitive check-up, immunisations, etc. (Vorsorgeuntersuchung) then you don't need to pay the €10 - this only applies if you want/need treatment, and in any case only applies to those that are state ("gesetzlich") insured (as the AOK insurance probably is)

Not true almost there breath. I went to get a refill on a prescription and they still wanted €10. They want €10 per quarter regardless and unless things have changed, the quarter included both doctors and dentists. As a copay, that is CHEAP! With my HMO in the States, my copay was anything from $15 to $50 depending on who I saw and that was per visit and the monthly premiums out of my paycheck was close to $300 per month as a single healthy male.

I am on AOK, along with my son, and I find them A-OK! They cover what you need and the extras that you don't need (although you may be convinced that you do) cost extra. Depending on the ENT office, you may need to get a prescription from your GP. Mostly they need this for the insurance game. It is easy enough to do, so just play along.
Mariposa
eurovol, I only know that my dentist only charges the €10 is something has to be done on my teeth (fillings etc.). Not sure about other doctors but refilling a prescription might not count as preventative check-up and well it really isn't (I had the same issue right before I left for Spain. Had to refill a prescription and pay the €10 just for that, knowing I would not go to the doctor anymore during that quarter as I would not even be in Germany.)
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