IGeLn You?

The world of acronyms is a big one: terms formed from the first letters of individual words are appearing with increasing frequency. “IGeL” is one such acronym. And in this case, it refers neither to the “Community of Interest of Labyrinth Fishes”, nor to the “Institute for Holistic Learning“, nor to any other institution. “IGeL” is the acronym for “Individual Health Services”. This means, first of all, all diagnostic and treatment options that are not covered by statutory health insurance.

SINGLE or show spines?

A total of 79 items from the so-called service catalog of the statutory health insurance (GKV) are currently IGeL. These include, among others:

  • Travel medical advice and appropriate vaccination advice
  • Travel vaccinations
  • Fitness examinations for example for travel, airworthiness, diving.
  • Sports medicine examinations and consultations
  • Allergological occupational aptitude tests (eg, baker, hairdresser).
  • Medical-cosmetic services such as the removal of tattoos.
  • Aesthetic operations
  • Tests for the compatibility of cosmetics.
  • Blood grouping on request
  • Additional preventive examinations on request

Many useful examinations

With many IGeL services, it is easy to see why they should not be paid by health insurance, but are still useful. For example, if you want to take a vacation in the tropics, you should definitely have your “fitness for the tropics” checked by a doctor beforehand. Together with the appropriate vaccinations, you can be well prepared for your vacation without having to pay for your health insurance. Vacation is private pleasure – and the correct vacation preparation does not fall into the financing task of the health insurance. The allergological occupational aptitude tests, some of which are prescribed by the employers’ liability insurance associations, are also useful. For example, if you want to become a baker, you should be tested for a possible allergy to flour dust before you start work; hairdressers or bricklayers come into contact with chemicals to which they may be allergic. Therefore, a clarification before starting a profession is important – and this is also possible without health insurance contributions. The situation is similar, for example, with the glaucoma examination at the ophthalmologist, which makes sense for patients over the age of 40 and can prevent blindness later on. This disease goes unnoticed without examination and cannot be adequately treated at a later stage.

Cure or cash in?

According to a study by the Scientific Institute of the AOK (WIdO) and the NRW Consumer Center, almost a quarter of all insured persons (23.1%) have been offered an individual health service. This offer is clearly made to a rather high-income and educated group of patients, as the study found. For patients, the situation is often as follows: When talking to the doctor, it becomes clear that a faster or even better clarification is possible through additional tests. However, these must then be paid for privately. At this point, many patients feel pressured, because they are dependent on the competence and expertise of their doctor. However, a serious offer from the doctor’s office will always give the patient enough time to consider the situation and obtain comprehensive information. If the doctor’s offer is based on an acute and concrete emergency, the costs would be covered by the health insurance anyway. The Federal Medical Association also describes the range of IGeL services as a balancing act between “healing and cashing in”, because in its opinion the statutory health insurance no longer guarantees the necessary medical care in all areas. At the upcoming German Medical Congress in May 2006 in Madgeburg, a revised list of IGeL services is to be presented and discussed.

Creating one’s own transparency

Anyone who is offered an “individual health service” in the doctor’s office should accept it as such: An offer that, from the physician’s point of view, is medically indicated in the individual case. Anyone who does not understand the meaning and purpose of the proposed examination should ask specifically and emphatically about the meaning and purpose of the additional examinations. No physician may perform and bill for an individual service against the declared will of the patient.No patient should be forced to make an immediate decision during the examination or interview. Anyone who has doubts about the necessity of the proposed examinations should seek a second opinion if in doubt. The patient’s own health insurance company is also a good contact at this point.

First the consent, then the examination

In principle, additional services that are billed privately must always be recorded in a written agreement before the service is used. In this agreement, the patient must be expressly informed of the costs to be borne by him and declare his consent in writing. If this declaration of consent is not provided, the physician may not bill the patient. The amount of the invoice is based on the German Medical Fee Schedule (GOÄ). Since every invoice is based on a complicated billing system, the patient should also have the price of his examination explained to him and, in case of doubt, ask the medical association. For patients, this means:

  • Have it explained to you exactly how you will benefit from the examination and what consequences you should expect.
  • Do not be pressured and take your time to make your decision.
  • If in doubt, get a second opinion.
  • Before claiming, ask your insurance company why the cost of this service is not covered.

It is generally prohibited to offer such services against invoice, which are actually health insurance benefits. If patients are asked by their doctor with reference to the exhausted budget for private payment, the health insurance company and the medical association should be involved.Some patient advice centers offers the social association VdK Germany. In addition, information can also be obtained from the consumer centers. Stiftung Warentest has also studied the various cancer screening examinations and published its findings in the book “Untersuchungen zur Früherkennung. Cancer – Benefits and Risks”. The book can be ordered there directly or through bookstores. The German Medical Association, together with the North Rhine Medical Association, provides information in a brochure about individual individual services.