Getting to specialist doctor's appointment

19 posts in this topic

Hi, I've been living for some time in Germany for now and I have public health insurance in TK.

 

I haven't needed a doctor until now and I would like to know how to get to a specialist appointment. I'm dealing with a specific problem I am very aware of and only specialist can help me, so there's no use of GP(General practitioner).

 

1. Do i need a referral letter from the GP to get appointment with specialist doctor and coverage of required treatments by insurance? - This would be the primary goal.

2. If the GP will not issue me a referral letter, how easy it is to swap the GP, will I be tied somehow?

3. With a referral letter, can I visit 2 specialist doctors for second opinions? Or do i have to get another referral from the doctor?

4. To get to the GP appointment, do I need to register myself to their patient list, or I can just use their service once?

5. Do i need to find a GP near my residential location or the system is connected throughout the country? I'm located in Cologne and the specialist doctor is also in Cologne, so if I use GP in e.g. Berlin, how is that considered?

6. Is the a way to have the GP visit "virtual", like an online appointment or something? Do you know any GP doctors who offer this service?

 

Thanks

 

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I would check with your health insurance if you need a referral or not.  

Depending on the insurance company and the issue they might first require a GP referral or not.

 

You should also check if the insurance company would pay for a second opinion.  Although why you are asking this when you haven't even heard what the first opinion is I don't know!

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OP has tk.  provided they're not trying to book a private specialist, they should be good to go (unless the doctor requires a referral for some reason - if that is the case they will ask if you have one when you call or visit them, before booking the appointment)

 

https://www.tk.de/techniker/leistungen-und-mitgliedschaft/mitgliederservice/arzt-und-krankenhausbesuch/haeufige-fragen-zur-aerztlichen-behandlung/ueberweisung-arzt-facharzt-2008518

 

the only time I've needed an Überweisung with TK was for an MRI.  I have booked more appointments with specialists than with my GP.  the referral is not generally required for insurance purposes.

 

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11 hours ago, lisa13 said:

OP has tk.  provided they're not trying to book a private specialist, they should be good to go (unless the doctor requires a referral for some reason - if that is the case they will ask if you have one when you call or visit them, before booking the appointment)

 

https://www.tk.de/techniker/leistungen-und-mitgliedschaft/mitgliederservice/arzt-und-krankenhausbesuch/haeufige-fragen-zur-aerztlichen-behandlung/ueberweisung-arzt-facharzt-2008518

 

the only time I've needed an Überweisung with TK was for an MRI.  I have booked more appointments with specialists than with my GP.  the referral is not generally required for insurance purposes.

 

 

With a few exceptions, a referral is always necessary, see https://www.tk.de/techniker/leistungen-und-mitgliedschaft/mitgliederservice/arzt-und-krankenhausbesuch/hausarzttarif/ueberweisung-pflicht-hausarzttarif-2008254

 

Since TopNotch doesn't say what kind of specialist he needs, it's impossible to say if he needs a referral.

 

12 hours ago, TopNotch said:

 I'm dealing with a specific problem I am very aware of and only specialist can help me, so there's no use of GP(General practitioner).

(...)

3. With a referral letter, can I visit 2 specialist doctors for second opinions? Or do i have to get another referral from the doctor?

(...)

6. Is the a way to have the GP visit "virtual", like an online appointment or something? Do you know any GP doctors who offer this service?

 

So you think you already know exactly what you have, would like to have it confirmed by not just one but two specialists and not see either of them personally, but they should make their diagnoses online?

 

That sounds rather strange - talk to the TK, not that you end up sitting on costs. 

 

"Wichtig: Gehen Sie zu einem anderen als zu dem von Ihnen gewählten Hausarzt oder suchen Sie ohne Überweisung einen Facharzt auf, können Mehrkosten auf Sie zukommen."

 

https://www.tk.de/techniker/leistungen-und-mitgliedschaft/mitgliederservice/arzt-und-krankenhausbesuch/hausarzttarif/ueberweisung-pflicht-hausarzttarif-2008254 

 

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Sorry, but @lisa13 is right and @someonesdaughter is not.

 

What someonesdaughter linked to are the specific provisions of the "Hausarzttarif" of TK, i.e. if you signed an extra contract in which you committed yourself to always go through your GP (you can get out of that extra contract again, by terminating it after the minimum duration of 1 year):  https://www.tk.de/techniker/leistungen-und-mitgliedschaft/mitgliederservice/arzt-und-krankenhausbesuch/hausarzttarif-2008176

 

Normal membership in TK is just like lisa described, you go directly to any specialist you like (and you can also get a second or third opinion from another Facharzt of the same specialty, i.e. go to multiple Fachärzte of the same specialty):  https://www.bundesgesundheitsministerium.de/themen/krankenversicherung/grundprinzipien/freie-arztwahl.html

 

The only exception are a few branches of specialists (Fachärzte) for which you still need an Überweisung (referral), but they are not exactly run-of-the-mill: https://www.aerzteblatt-sachsen-anhalt.de/ausgabe/recht-aktuell/135-recht-0102-2014/486-ueberweisungen-auch-ohne-praxisgebuehr.html

  • Laboratoriumsmedizin (laboratory medicine)
  • Mikrobiologie und Infektionsepidemiologie (microbiology and infectious epidemiology)
  • Nuklearmedizin (nuclear medicine)
  • Pathologie (pathology - if you need one of those your problems are already over...)
  • Radiologische Diagnostik bzw. Radiologie (radiology)
  • Strahlentherapie (radiotherapy)
  • Transfusionsmedizin (transfusion medicine)

 

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36 minutes ago, PandaMunich said:

What someonesdaughter linked to are the specific provisions of the "Hausarzttarif" of TK, i.e. if you signed an extra contract in which you committed yourself to always go through your GP (and which you can also get out of again, by terminating it after 1 year):

 

Panda's right, I got the wrong side.

 

However, I keep up my recommendation to talk to TK first, because

 

36 minutes ago, PandaMunich said:

 

Normal membership in TK is just like lisa described, you go directly to any specialist you like (and you can also get a second or third opinion from another Facharzt of the same specialty, i.e. go to multiple Fachärzte of the same specialty):  https://www.bundesgesundheitsministerium.de/themen/krankenversicherung/grundprinzipien/freie-arztwahl.html

 

the link also says:

 

"Allerdings gibt es auch in Deutschland Einschränkungen. So können in der GKV regelmäßig nur die an der vertragsärztlichen Versorgung teilnehmenden Ärzte beziehungsweise Zahnärzte frei gewählt werden. Andere Ärzte dürfen nur im Notfall in Anspruch genommen werden. Vorgesehen ist zudem, dass die Versicherten den Arzt innerhalb eines Kalendervierteljahres nur beim Vorliegen eines wichtigen Grundes wechseln sollen."

 

I can't see any emergency here and without knowing which specialists the op thinks they need, I wouldn't tell him 'Just do it' – especially as medical specialists can reject new patients without referral):

 

"Dennoch kann es dem spezialisierten Facharzt berufsrechtlich nicht verwehrt werden, wenn er insbesondere Neupatienten nur unter dem Vorbehalt einer Überweisung behandelt, weil dies beispielsweise zur Steuerung der Patientenströme erforderlich ist."

 

Quote

 

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that only applies if he tries to visit a doctor who is not participating in kasse funded medicine - ie a private practice.

 

there is no reason whatsoever he can't call a specialist.  As you say, the worst that can happen is they tell him they want a referral, but I personally have never had that happen aside from the aforementioned MRI.  Heck, I arranged surgery without any referrals.  I always asked if they wanted one when making an appointment and they always, very emphatically said "NO!  you don't need it"

 

The only reason I can see the OP should call TK is to verify that he's not under a Hausarzttariff (I doubt it as he hasn't even been to a HA in Germany) as then, yes, all of the info somonesdaughter gave definitely applies.

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If you want to see an Osteopath and your Krankenkasse offers some partial refund for Osteopathic treatment, you often also need a referral in advance.

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12 hours ago, PandaMunich said:

Sorry, but @lisa13 is right and @someonesdaughter is not.

 

What someonesdaughter linked to are the specific provisions of the "Hausarzttarif" of TK, i.e. if you signed an extra contract in which you committed yourself to always go through your GP (you can get out of that extra contract again, by terminating it after the minimum duration of 1 year):  https://www.tk.de/techniker/leistungen-und-mitgliedschaft/mitgliederservice/arzt-und-krankenhausbesuch/hausarzttarif-2008176

 

Normal membership in TK is just like lisa described, you go directly to any specialist you like (and you can also get a second or third opinion from another Facharzt of the same specialty, i.e. go to multiple Fachärzte of the same specialty):  https://www.bundesgesundheitsministerium.de/themen/krankenversicherung/grundprinzipien/freie-arztwahl.html

 

The only exception are a few branches of specialists (Fachärzte) for which you still need an Überweisung (referral), but they are not exactly run-of-the-mill: https://www.aerzteblatt-sachsen-anhalt.de/ausgabe/recht-aktuell/135-recht-0102-2014/486-ueberweisungen-auch-ohne-praxisgebuehr.html

  • Laboratoriumsmedizin (laboratory medicine)
  • Mikrobiologie und Infektionsepidemiologie (microbiology and infectious epidemiology)
  • Nuklearmedizin (nuclear medicine)
  • Pathologie (pathology - if you need one of those your problems are already over...)
  • Radiologische Diagnostik bzw. Radiologie (radiology)
  • Strahlentherapie (radiotherapy)
  • Transfusionsmedizin (transfusion medicine)

 

 

Thank you, that solved my problem.

 

I've now got an appointment for the specialist doctor. Both TK and doctors office confirmed that I don't need a referral from the GP.

 

Thank you all for the information, all the answers were very helpful.

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My orthopedist told me that in "emergencies" I should just turn up in the morning instead of waiting for weeks popping pain killers as I have just done recently. :-I

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On 8/16/2019, 11:00:48, TopNotch said:

I've now got an appointment for the specialist doctor. Both TK and doctors office confirmed that I don't need a referral from the GP

Even though there is no requirement it´s still a good idea to go via a GP because that ensures that your GP will receive a specialist report so that all your medical information will be stored at one place. Which can become helpful e. g. if you don´t remember in a few years what examinations/treatments have taken place in the past and by who and with which result.

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46 minutes ago, jeba said:

Even though there is no requirement it´s still a good idea to go via a GP because that ensures that your GP will receive a specialist report so that all your medical information will be stored at one place. Which can become helpful e. g. if you don´t remember in a few years what examinations/treatments have taken place in the past and by who and with which result.

But specialists usually have a form that you fill out that asks for your GP's information.  At least all of the specialists I've been to.  Last week I saw a specialist, and they printed out their findings on a letter addressed to my doctor because I had filled out the form with her information the first time I saw that specialist.  

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13 hours ago, Santitas said:

But specialists usually have a form that you fill out that asks for your GP's information.  At least all of the specialists I've been to.  Last week I saw a specialist, and they printed out their findings on a letter addressed to my doctor because I had filled out the form with her information the first time I saw that specialist.  

I have been told that I can ask to have that report given directly to me for my files. I don't yet have a Haus Arzt and I have already made an appt with an orthopedist.

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4 hours ago, BethAnnBitt said:

I have been told that I can ask to have that report given directly to me for my files. I don't yet have a Haus Arzt and I have already made an appt with an orthopedist.

It´s still a good idea to have a Hausarzt  since chances are he can interpret reports better than you and do a synopsis of reports from different specialists.

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10 hours ago, BethAnnBitt said:

I have been told that I can ask to have that report given directly to me for my files.

 

yes you can.

 

It is important to get these reports for your own reference, and you should also be sure to share them with any other doctors who are treating the same or similar problems.  If you ever settle on a hausarzt you can share it with them too, and you probably should if it's an ongoing issue.  

 

the best reason I've found to have a hausarzt is for sick notes and general checkups.  If I have a more serious problem I usually go straight to a specialist as it cuts out the middle man and reduces the time to treatment.

  

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1 minute ago, lisa13 said:

 

yes you can.

 

It is important to get these reports for your own reference, and you should also be sure to share them with any other doctors who are treating the same or similar problems.  If you ever settle on a hausarzt you can share it with them too, and you probably should if it's an ongoing issue.  

 

the best reason I've found to have a hausarzt is for sick notes and general checkups.  If I have a more serious problem I usually go straight to a specialist as it cuts out the middle man and reduces the time to treatment.

  

I agree on all these points and I appreciate the confirmation.  I actaully started out by going to a Haus Arzt, but she was CRAZY.  It was a very disappointing experience.  So I decided not to go back.  Among other things she started talking about politics during the interview.  My German friends here were appalled.

 

And then I realized that I can go straight to the specialist anyway.  I come from a health care background myself and I am very used to advocating for myself.  

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yep - met my share of those too :)

 

my current hausarzt isn't crazy but he's pretty useless outside of dishing out sick notes. 

 

If you decide to look for a new one, I recommend focusing on doctors who also have an internal medicine specialty.  The internal medicine docs I've been to are night and day better than the general/basic/Algemeinmedezin "hausarzt".  Another advantage is they often have better diagnostics in house (ultra sound, at least).  I always assumed all of them specialized in internal medicine but apparently not.  so look for one who has Inneremedizin as part of their credentials. 

 

No guarantee but I think you have a better shot finding a good one using this rule of thumb. You will probably need one eventually anyway, so it's good to find one when you're not under duress.

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