Payment of treatment costs
Statutory health insurance
AOK Bayern was the first statutory health insurance plan to conclude a contract for the provision of proton radiation with the RPTC for its policyholders. The Bavarian Association of Company Health Insurance plans (BKK) and the Bavarian Agricultural Health Insurance plans have also signed appropriate contracts with the RPTC, these being effective for all of Germany. Other health insurance plans are following suit. As a result, the proton therapy provided at the RPTC in Munich is a benefit provided by many statutory health insurance institutions. Moreover, policyholders benefit from the entitlement to a choice of a service provider (i.e. a proton centre), which has been in effect since the beginning of 2004. Accordingly, they can request the reimbursement of costs from their local insurance plan (§ 13 (2,3) SGB V).
Patients from the EU
Patients from EU member states also come under the principles of freedom to provide services; consequently, they are entitled to seek outpatient treatment in Germany and obtain the reimbursement of costs from their corresponding foreign insurance providers. Therefore, a national system for payment-in-kind does not preclude a claim for cost reimbursement. A patient from another EU member state can claim for reimbursement of costs, if he or she has proton radiation in Germany. This also applies to patients living in EU countries other than Germany, who travel to Germany specifically for treatment. There is a formalized accounting procedure for the settlement of treatment costs between the foreign health insurance plan and the relevant German plan. The foreign insurance system may require the patient to comply with certain formal conditions (for example, the treatment may only take place following referral by a family doctor), but the plan must not discriminate or obstruct the right to freedom of services.
Private health insurance
The individual insurance contract is applicable for private health insurance. As a general tip, insurance companies are basically obliged to pay for therapies such as photon radiation, particularly in light of the judgment handed down by Germany's Federal Court of Justice on 12/3/2003 (AZ IV Z R 278/01).