Privates Institut für Laser-Proktologie seit 2012
Privates Institut für Laser-Proktologie seit 2012
Clinic · Fees
We accept all German statutory health insurance plans. Here you can find out what your health insurance pays for, how we bill privately insured patients and when you pay yourself.
Before an examination or treatment, you will want to know what it costs and whether you have to pay for it yourself. Here is an overview:
Statutory health insurance
You receive all services in our specialty that statutory health insurance covers. You do not pay anything up front, not even for outpatient surgery (benefits-in-kind principle).
Private insurance and self-pay
You receive an invoice based on the official German fee schedule for physicians (GOÄ). The amount depends on the type and scope of the services and, where applicable, on the individual effort involved.
Not covered by your plan
If a useful treatment is not covered by your health insurance, we will let you know and discuss the alternatives with you.
The Proctology Practice Munich is a joint practice with two equal partners, Dr. Bernhard Hofer and Florian Liebl. Dr. Susanne Schuster currently works with us as an employed physician. All three are authorized to treat patients with statutory health insurance. The practice is also licensed to perform outpatient surgery under Section 115b SGB V.
In Germany, patients are insured either with a statutory health insurance fund (GKV) or with a private health insurer (PKV). Private patients and self-payers are billed under the GOÄ, the official fee schedule for physicians. If you are insured abroad, please ask your insurer before treatment whether and to what extent it will reimburse the costs.
This is governed by Book V of the German Social Code (SGB V). The key rule is the principle of efficiency in Section 12(1) SGB V: services must be sufficient, appropriate and economical. They must not exceed what is necessary.
A treatment is sufficient if it ensures adequate medical care. It is appropriate if it is suitable for achieving the treatment goal. It is economical if benefits and costs are reasonably balanced. And a service is necessary only to the extent that it is actually required for your care.
In addition, Section 2(1) SGB V requires services to reflect the generally accepted state of medical knowledge and to take medical progress into account.
Individual health insurance funds cannot decide this at their own discretion. What counts are the legal requirements, the decisions of the Federal Joint Committee (G-BA) and, for outpatient billing, the Uniform Assessment Standard (EBM).
This is why not every treatment that is medically useful or recommended in a guideline is automatically covered. For methods not included in the benefits catalog, exceptions are only possible under very narrow conditions.
Preventive laser hair removal after a pilonidal sinus (tailbone cyst) can be medically useful and supported by guidelines. Even so, applications for coverage are often rejected. A recurrence is very unpleasant and may require further surgery. However, it is generally not considered life-threatening or comparably serious. This means the narrow conditions for an exception are usually not met.
Under Section 13(2) SGB V, patients with statutory health insurance can choose cost reimbursement instead of the usual benefits in kind. You first pay the invoice yourself and then submit it to your health insurance fund.
You must inform your insurer of this choice before treatment begins. It does not apply to a single treatment only but binds you for at least one calendar quarter. You can, however, limit it to certain areas, such as medical care.
Your insurer reimburses at most the amount it would have paid as a benefit in kind, minus an administrative fee of up to five percent and any co-payments. You pay the rest of the invoice yourself. So please seek advice from your insurer beforehand and make sure you understand the financial risks. As a rule, we advise against this option.
For certain operations there is a special form of remuneration, the so-called hybrid DRG. It is intended to allow suitable procedures to be performed on an outpatient basis, without a hospital stay. Until the end of 2026, statutory health insurance therefore also covers innovative procedures such as laser surgery for a pilonidal sinus (tailbone cyst), with no out-of-pocket costs for you. What happens after that is uncertain: the governing coalition plans to abolish hybrid DRGs without replacement in 2027.
Under integrated care, health insurance funds can conclude special contracts directly with physicians, hospitals or other providers. In the past, such contracts also allowed individual treatment pathways and remuneration for outpatient surgery outside standard care.
Since hybrid DRGs were introduced, these contracts have lost much of their importance for outpatient surgery. Even if hybrid DRGs are abolished again, it is currently not foreseeable that the earlier contract models will return on a larger scale. For you, this means: coverage through such a contract is possible in principle, but currently only in a few cases.
With selective contracts, individual health insurance funds can agree on special care offers with selected providers. Such offers also exist in proctology. However, they only apply to members of the respective fund and only with participating providers. They are therefore not a general alternative to standard statutory care. If in doubt, ask your health insurance fund directly.
Services that statutory health insurance does not cover can be obtained at your own request as individual health services (IGeL). You are then treated as a private patient, and we bill according to the German fee schedule for physicians (GOÄ). This requires that you expressly request the service and that we agree on it in writing before treatment begins. The agreement also states that you are responsible for the costs. A verbal agreement is not sufficient.
Important: Self-payment applies to the entire service. If an operation is not covered by statutory health insurance, all related services are billed privately as well, for example anesthesia. You cannot pay for the operation yourself and have the anesthesia billed to your insurer. Please ask for an estimate of the total costs in advance.
We bill all medically necessary covered services directly to your health insurance fund.
If a useful treatment is not covered, we will let you know and discuss the alternatives with you.
Billing under the official German fee schedule (GOÄ)
Unlike lawyers or tax advisors, for example, physicians in Germany cannot freely set their fees by hourly rates or flat fees. Billing is regulated by law and follows the fee schedule for physicians (GOÄ).
The GOÄ contains a catalog of individual medical services, each with a set fee. A so-called multiplier adjusts the fee to the difficulty, the time required and the particular circumstances of a treatment.
For most services, a multiplier of 2.3 is standard. For particularly difficult or time-consuming treatments, it can be increased to 3.5 with a justification.
The current GOÄ was last comprehensively revised in 1996. As a result, many modern examination and treatment methods are not explicitly listed.
For such services, the GOÄ provides for analogous billing: a service that is not listed is billed according to a listed service that is equivalent in type, cost and time required.
The German Medical Association (Bundesärztekammer) publishes recommendations and analogous ratings to make billing as consistent and transparent as possible. Physicians may also make their own analogous ratings, provided these meet the legal requirements.
For particularly complex or specialized treatments, the actual medical effort can exceed what the GOÄ reflects with its standard rates.
In such cases, the GOÄ allows an individual fee agreement under Section 2 GOÄ. A higher multiplier is agreed in writing for certain services before treatment begins. It may also exceed the standard maximum of 3.5.
Important for privately insured patients: Private health insurers and government allowance offices (Beihilfe) do not fully cover such increased fees. Amounts above the standard maximum rates in particular are often not reimbursed. You then pay the difference yourself.
If an individual fee agreement is needed for your treatment, we will discuss it with you in advance. You will learn which services are planned, what they cost and which share your insurance may not cover. This way, you can make your decision on a clear and transparent basis.
We want you to be able to afford your treatment. Through our financial services provider BFS health finance, you can pay your invoice in installments or extend the payment deadline.
Use the installment calculator to find out, without obligation, which term and installment amount suit you. You then conclude the agreement in the online service or the BFS app, using the access details on your invoice. The installments are debited automatically from your account on the agreed dates.
Installment payments may involve costs. The calculator shows you the exact terms in advance. Please note that the BFS website is in German.
Too complicated?
What does the initial proctological examination and consultation cost?
Statutory health insurance: Your insurer covers the examination, and we bill it directly. Private insurance or self-pay: You receive an invoice under the GOÄ. For an average examination, the fee is about €200 to a maximum of €300, depending on the examination steps required.
Does health insurance cover preventive laser hair removal?
Statutory health insurance: The expert guideline on pilonidal sinus now recommends this treatment to prevent new fistulas. Even so, statutory health insurance does not currently cover the costs. Insurers usually refer applications for a case-by-case decision to the Medical Service (Medizinischer Dienst), and they are generally rejected. For patients with statutory insurance, we offer reduced rates: currently €95 per treatment and €400 for a package of 5 treatments.
Private insurance or self-pay: Depending on the extent of the treatment, we bill analogously according to the recommendation of the German Medical Association, using code A2440 or A2885. Private insurers reimburse this fee in most cases but occasionally ask for a medical justification.
Is laser surgery for a pilonidal sinus covered by health insurance?
In 2026, yes. Through the so-called hybrid DRG, statutory health insurance also covers laser procedures for pilonidal sinus with no out-of-pocket costs. What happens after that is uncertain: the governing coalition plans to abolish this form of remuneration without replacement in 2027.
What applies if I pay for a service myself, e.g. as an IGeL service?
Patients with statutory insurance are then treated as private patients and billed under the GOÄ. This requires a written agreement before treatment begins; a verbal agreement is not sufficient. Self-payment applies to the entire service: if an operation is not covered, anesthesia is billed privately as well. Please ask for an estimate of the total costs in advance.
How do you bill private and self-pay patients, and what is a fee agreement?
We bill according to the official German fee schedule for physicians (GOÄ). The standard multiplier is 2.3; for particularly difficult or time-consuming treatments, up to 3.5 with a justification. For very complex treatments, an individual fee agreement can be made in writing in advance, including above 3.5. Private insurers and government allowance offices often do not fully reimburse amounts above that. You pay the difference yourself. We discuss this with you beforehand.
Can I pay my invoice in installments?
Yes. Through our financial services provider BFS health finance, you can pay your invoice in installments or extend the payment deadline. Use the installment calculator to work out the term and installment amount without obligation. Installment payments may involve costs, which the calculator shows in advance.
Please get in touch. We are happy to answer your questions before or during your appointment.
