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Patients with private health insurance
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Patients with private health insurance

Costs for private health insurance patients

Prices for patients of private health insurance companies

For private patients, billing is carried out in accordance with the legal requirements using the GOÄ (Fees Regulation for Medical Billing). Billing is carried out according to the so-called single-service principle. Usually, in the case of private patients, the so-called threshold value is used, which ensures the appropriate remuneration for a corresponding part of the service. The threshold value for general medical services is 2.3, for laboratory services it is 1.8.

Invoices exceeding this so-called threshold value require individual justification. The factor of 1.0 must not be exceeded. Similarly, lump-sum pricing and the gifting of services are prohibited.

As with GKV patients, it is advisable, although not necessarily required, to have the health insurance company confirm the cost coverage before starting treatment.

Unlike with GKV patients, the couple does not have to be married; the woman does not have to be under 40 years old in order to obtain reimbursement.

Requirements for cost reimbursement are:

  • The PKV-insured partner must be the „causer“ of the sterility. The „causer principle“ applies.
  • At least if the woman is 40 years old or older, various information is required that proves that fertility treatment is „meaningful and promising“ for this woman. To this end, information about the cycle, various hormone levels, including AMH (Anti-Müller hormone), are requested. Usually, private health insurance companies refuse to cover costs after a (female) age of 45.

Costs

  • Insemination cycle
    approx. 400.00 to 600.00 EUR, plus medication costs (50.00 to 500.00 EUR)
  • MINI IVF
    approx. 2,000.00 to 3,000.00 EUR, plus medication costs (300.00 to 4,000.00 EUR), additionally, if applicable, cryopreservation
  • ICSI (conventional ICSI)
    approx. €3,500 to €5,500 (when calculating ICSI for 5 eggs), plus medication costs (300.00 to 4,000.00 EUR), additionally, if applicable, cryopreservation
  • Mini ICSI
    approx. €3,500 to €5,500 plus medication costs (300.00 to €4,000), additionally, if necessary, cryopreservation

Additional benefits that are usually excluded from reimbursement:

  • HALO sperm test
    (160,00 EUR)
  • Cryoconservationg of fertilized eggs
    (approx. 400.00 EUR)
  • Rental for a storage period of six months
    (125.00 EUR)
  • Cryo cycles with the aim of transferring previously frozen fertilized eggs
    (approx. 450.00 to 600.00 EUR), plus medication costs of approx. 100.00 to 500.00 EUR
  • Assisted Hatching (Laser guidance system) approx. 170 euros
  • Polycystic ovary diagnosis
    (between 900.00 to 1,600.00 EUR)
  • The Treatment with donor sperm (Costs can be found with our partner) Berliner Samenbank)

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Patients with German statutory health insurance

GKV insured persons (legal health insurance) must obtain reimbursement of the costs before the start of the artificial insemination procedures. Usually, this period is 1 year.

Patients with private health insurance

PKV policyholders are not required to obtain a cost reimbursement before treatment begins; however, it is advisable to at least do so for cost-intensive treatments such as IVF and ICSI.

Self-paying patients

Self-payers are GKV or PKV patients for whom cost coverage by the statutory health insurance is not available, or private patients without the possibility of cost coverage through their private health insurance.

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