What does an online doctor cost in Germany? GOÄ, private prescriptions and reimbursement

Why an online doctor costs something

The German health system knows two routes to medical services. In statutory care, the practice bills the Association of Statutory Health Insurance Physicians; for statutorily insured people the visit is free, in return there are consulting hours, appointment waiting times and a fixed catalogue of services. In private care you conclude a treatment contract directly with the doctor and pay under the fee schedule for doctors. Privately insured people know this as the normal case; for statutorily insured people it is an optional service.

OpenClinic24 works privately. This allows requests around the clock, a video consultation without a waiting room, advice in four languages and prescriptions that are not provided for in statutory care. The price for this is that you pay for the service yourself or submit it to your private insurer. This article explains how the costs arise so that you know what to expect before booking.

How the GOÄ works

The fee schedule for doctors (Gebührenordnung für Ärzte) is a federal regulation. It contains a list of all medical services with codes and point values. The single rate of a service results from points times point value (5.82873 cents). A factor is applied to this, reflecting difficulty and time: up to 2.3-fold without justification, up to 3.5-fold with written justification on the invoice. The 2.3-fold rate is the usual standard rate.

Under section 12 GOÄ every invoice must show date, code, description of the service, factor and amount. This makes private medical invoices fully traceable and comparable; it is exactly this transparency that is missing from providers who charge flat fees without codes.

What OpenClinic24 charges

The most common items of a video consultation, each at the 2.3-fold rate:

GOÄ code	Service	Amount
No. 1	Consultation, also by telephone or video	€10.72
No. 3	In-depth consultation of at least ten minutes	€20.11
No. 1 plus no. 5	Consultation with symptom-related examination, for example review of a skin or throat finding by video	€21.44
No. 2	Issue of a repeat prescription without a new consultation	single rate €2.33
No. 70	Short certificate, for example sick note	single rate €2.33
Nos. 1, 801, 75	ADHD assessment: consultation, in-depth psychiatric examination, written report	€61.67

At booking, €10.72 is reserved on your card, the amount of the basic consultation. Nothing is charged until after the consultation, in the amount of the services actually provided. You see the expected total for your chosen treatment before confirming; for programmes with several consultations, such as medically supervised weight loss, the items are listed on the respective page. Invoice and, where applicable, private prescription or certificate are then available as PDFs in your patient account.

Important to know: the service is the medical consultation, not the document. If the doctor decides that a prescription or sick note is not medically justifiable, the consultation was nevertheless provided and is charged. This rule protects you: a provider that only earns when issuing documents would have an incentive to grant every request.

Statutorily insured: what you pay and what you do not

Statutory health insurers do not reimburse private medical services as a rule. This also applies if you have chosen cost reimbursement under section 13 SGB V, because this refers to providers with statutory accreditation. You therefore pay the GOÄ invoice yourself. The same applies to medicines on private prescription: you pay the full price at the pharmacy instead of the co-payment.

Some groups of medicines are excluded from statutory cover anyway, regardless of who prescribes them: medicines for erectile dysfunction, smoking cessation and weight reduction (section 34 SGB V). Here the private prescription makes no difference. Travel medicine and many preventive services are also paid privately.

What may still speak in favour of the private online doctor for you as a statutorily insured person: no waiting for an appointment, availability in the evening and at weekends, advice in English, Turkish or Arabic, discretion for intimate topics, and a sick note or prescription without having to go into a waiting room while ill. Whether that is worth the price is your decision in each case. You get a sick note for a cold free of charge at your GP practice; but if the next appointment there is the day after tomorrow, the video consultation has its value.

Privately insured or entitled to civil servants’ aid

For privately insured people the GOÄ invoice is the normal case. Submit it to your insurer; reimbursement follows the tariff, usually up to the 2.3-fold or 3.5-fold rate, minus an agreed excess. Civil servants also submit the invoice to their aid office, which reimburses its share according to the aid rate. Medicines on private prescription are also reimbursed according to tariff; keep the pharmacy receipt. With excess tariffs it is worth considering whether to collect invoices or go a year without submitting in order to receive a premium refund.

Tax: extraordinary expenses

Medical costs that nobody reimburses can be claimed as extraordinary expenses under section 33 of the Income Tax Act. Deductible is the part that exceeds the reasonable burden, which lies between one and seven percent of total income depending on income, family status and number of children. GOÄ invoices and pharmacy receipts are the evidence. For most people this is only worthwhile if larger medical costs accumulate in the year.

When the online doctor is free

The video consultation is free within statutory care: at your GP practice if it offers video consultations, at specialist practices with statutory accreditation and at telemedicine providers working with statutory doctors. There the rules of statutory care apply: appointments within consulting hours, the requirements of the incapacity guideline, statutory prescriptions with co-payment and no access to excluded medicines. For many concerns this is the right and cheapest route. The private online doctor complements it where speed, language, discretion or the type of service tip the balance.

Be wary of offers that promise “free” and then demand subscriptions, memberships or flat fees for documents without a medical consultation. A medical certificate without consultation is worthless, and a prescription after a questionnaire is not a medical prescription.

Three example invoices

Typical cases show how the items combine in practice. A short video consultation for a cold with a sick note: consultation under no. 1 (€10.72) plus certificate under no. 70; this total is charged, with the €10.72 reservation credited against it. A consultation for a skin rash with review of photos and prescription of a cream: consultation under no. 1 plus symptom-related examination under no. 5, together €21.44; you pay for the medicine at the pharmacy. An in-depth first consultation of more than ten minutes, for example on erectile dysfunction with clarification of cardiovascular risks: in-depth consultation under no. 3 at €20.11. In all cases you see the expected amount before confirming, and the invoice lists every code individually. If more time is needed in the consultation than expected, the doctor explains this before an additional item is charged.

What international studies say about video consultations

The video consultation is not a stopgap but, for clearly defined concerns, an equivalent form of care. Tuckson and colleagues describe in the New England Journal of Medicine how telemedicine improves access and continuity when embedded in a care system. Reed and colleagues show in JAMA Network Open that people choose video consultations above all when travel, waiting time or working hours make a practice visit difficult, and that the treating doctors can remain the same. Dorsey and Topol expect in the Lancet that telemedicine will move from exception to routine in the coming years, with clear limits where examination and technology are needed. That is exactly how we understand our role: fast, transparent, honest about limits.