Out of Pocket health services (referred to as IGeL in Germany) are medical, dental and psychotherapeutic services that patients generally have to pay for themselves because they are not part of the scope of benefits provided by statutory health insurance.
In Germany, Out of Pocket Health Services (IGeL) basically refer to:
- Individual health services are services provided by a doctor that patients have to pay for themselves. In Germany, they are called “IGeL” or “self-payer services” for short.
- IGeL are an additional offer. Patients are not obliged to accept them.
- There are different types of individual health services, from early diagnosis to plastic surgery. Often the benefit has not been proven.
- The IGeL market is confusing. Do some research before making a decision.
What does IGeL mean?
Individual health services are offered by many doctors, including psychotherapists and dentists. These are various diagnostic and treatment methods that go beyond the level of medically necessary medical care and do not belong to the stipulated catalog of services of the statutory health insurance (GKV). IGeL must be paid privately.
The IGeL market has been growing continuously for many years. There are no exact figures because self-payer services offered and billed are not systematically recorded. But according to projections by the health insurance companies, legally insured patients probably made use of a good 15 million IGeL in 2018 – and paid around one billion euros for it.
Which IGeL are there?
From intraocular pressure measurements to PSA tests, there is a wide range of IGeL services. A certificate can also be part of it, as can an extra ultrasound examination at the gynecologist or a new medical diagnostic procedure at the ophthalmologist. There are roughly two types of IGeL:
1. A service that is not medically necessary, but can be useful in individual cases :
There are medical examinations and consultations that take place at the request of the patient without being medically necessary. Such services are neither used for medical treatment nor for the early detection of diseases, they are therefore not part of the tasks of statutory health insurance and are therefore generally not paid for by the health insurance companies. In individual cases, however, it may be medically meaningful and recommendable services. Which includes:
- Medical certificates and services for leisure, sport and vacation
Examples: Sports medical examinations, advice before long-distance travel and travel vaccinations, examination and certification in the event of cancellation
- Medical-cosmetic services
There is usually no medical need here, for example for cosmetic surgery or removal of tattoos
- Psychotherapeutic services (e.g. couple therapies)
2. Medical services that are performed without justified suspicion of illness or with innovative treatment methods
The majority of the IGeL carried out in practice today are early diagnosis or preventive examinations. Examples are the ultrasound of the breast, the early detection of glaucoma (glaucoma) and the ultrasound of the ovaries or the carotid artery.
Some of these examinations are only taken over by the statutory health insurances in certain risk cases (family history) or if there is a justified suspicion of illness. In all other cases in which the additional examinations are carried out at the patient’s own request and without medical necessity, the costs must be paid for yourself.
Before you decide on an IGeL, find out whether this service makes sense for you. Once paid, you will not get the costs back from the cash register. You can also get help from your health insurance company. The IGeL Monitor of the umbrella association of health insurance companies offers scientifically tested and understandable specialist information on the most important IGeLs .
- Early detection tests in Germany: Prenatal care
- Early detection tests in Germany: Uterus
- Early detection tests in Germany: Colonoscopy / Gastrointestinal
- Early detection tests in Germany: Heart and vessels
Why don’t the health insurances pay?
Those with statutory health insurance are entitled to benefits for the prevention, early detection and treatment of diseases. The statutory health insurance companies are only allowed to pay for services that are sufficient, appropriate and economical. The Federal Joint Committee (G-BA), a committee made up of representatives from doctors and health insurers, decides which new medical services are to be included in this catalog of benefits.
Before health insurance companies pay for offers such as HRT (Heidelberg Retina Tomograph) or OCT (optical coherence tomography) laser-assisted eye examinations, the relevant scientific studies must be evaluated and the costs, benefits and harms weighed up. Both the health insurers and the doctors can apply for this.
In the case of OCT, for example, the study evaluation was positive, so that the G-BA decided in 2018 to make it a health insurance benefit, but only for the diagnosis and therapy management of neovascular age-related macular degeneration (nAMD) and macular edema in diabetic retinopathy (DMÖ).
Examination and treatment methods which the Federal Joint Committee has already rated as negative and which therefore may not be covered by health insurance are permitted as IGeL. Examples: ozone therapy, bioresonance therapy, colon hydrotherapy or ultraviolet radiation of the blood. According to a scientific analysis, these therapies are of no use, are medically not necessary or not economical.
- Some IGeL become a health insurance benefit if there is a specific suspicion of illness.
- IGeL can be offered without a quality check.
- If an examination or treatment method has been rated negatively by the highest decision-making body in the health system, it may not become a health insurance benefit. As an IGeL, however, it is allowed.
- Scientifically proven and understandable information on the most important IGeL is available from the health insurance company’s IGeL monitor.
Is there a valid IGeL list?
A multitude of different examination and therapy methods are hidden behind IGeL. Estimates assume several hundred offers. There is no binding list that provides information about the entire spectrum, just a compilation for doctors from 2011.
Every doctor can offer additional services that he has either developed himself or taken over from companies that specialize in IGeL. Since the range is broad and constantly expanding, patients hardly have a chance to check and compare the medical benefits, quality and price of the offers.