Private health insurance patients are not required to apply for a confirmation of cost coverage from their insurance provider before beginning treatment. However, this is recommended before beginning cost-intensive treatments such as IVF and ICSI.
In accordance with the legal requirements, the invoice process for private patients uses the GOÄ fee scale (German physician fees scale). Invoicing is based on what is known as the individual service principle. Generally, a threshold value is applied to private patients to ensure appropriate remuneration of the partial provision of services. The threshold value for general medical services is set at a factor of 2.3, and 1.8 for laboratory services, but this can be exceeded if justified. A factor below 1.0 is prohibited as are fixed fees and the gifting of services.
In contrast to statutory health insurance providers, couples with private health insurance do not have to be married and the women does not have to be under 40 for the insurance provider to agree to cover the costs. However, there must be a medical necessity and an appropriate chance of success.