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Insurance coverage for treatment costs

Payment of Charges

We will make every effort to take care of matters concerning treatment costs and lodging at the RPTC Guest House (for patients residing outside Munich) for you. We have a service provision contract with many statutory health insurance companies that allows us to bill the insurance company directly. Otherwise, we ask that you clarify your coverage with your health insurance company. We will send you the documents required for this purpose (estimate of costs and the associated medical necessity letter). We also do our best to simplify payment methods relating to therapy for patients with private insurance as well. We are currently in negotiations with several private insurance companies.

Statutory health insurance

AOK Bayern was the first statutory health insurance plan to provide coverage for proton radiation treatment at the RPTC for its policyholders. AOK Bayern also acts as a clearinghouse for AOK in other German states. Also the Federal Miners‘ Guild [Bundesknappschaft] and the Bavarian Agricultural Health Insurance Association [Landwirtschaftlichen Krankenkassen Bayern] have signed corresponding agreements with the RPTC. Additional insurance companies are pending. Other health insurance companies such as, for example, Engineers‘ Health Insurance Company [Techniker Krankenkasse] make decisions on proton therapy on a case-by-case basis. With very few exceptions, case-by-case decisions usually proceed smoothly. Therefore, for patients with whose providers we have a contract for provision of services, proton therapy at the RPTC in Munich is a service of the statutory health insurance companies. In such cases, we settle invoices directly with those insurance companies.
For all other patients, the Medical Service of Health Insurance Companies [Medizinischer Dienst der Krankenversicherung] is responsible for making decisions on a case-by-case basis. Fortunately, insured patients now have the right to select their service provider – i.e., a proton center – a rule that took effect at the beginning of 2004. Accordingly, they can request the reimbursement of costs from their local insurance plan (§ 13 (2,3) SGB V). In this case, Patient Management will draw up the cost estimate for you with the justification letter for you to submit to your insurance company. Communication regarding payment of charges generally is issued to the patient. Please notify Patient Management as soon as your payment of charges is assured by the insurance company, so that we can promptly schedule an appointment for you.

Patients from abroad

The freedom of service provision also applies to patients from EU member states; consequently, they are entitled to seek outpatient treatment in Germany and obtain reimbursement from their home-country insurance provider. Therefore, a national benefit-in-kind system does not preclude a claim for reimbursement. A patient from another EU member state can submit a claim for reimbursement 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 insurer and the relevant German insurer. Please request a copy of the required E 112 form needed from your insurer and send it to our Patient Management department along with a copy of your passport.The foreign insurance system may require the patient to comply with certain formal conditions (for example, the treatment may require a referral from a family doctor), but the plan must not discriminate or infringe on the patient’s right to freedom of services.

If your health insurance company does not use the E112 billing procedure, the cost estimate provided to you prior to the first treatment will establish the payment amounts. The cost estimate is individually generated based on the number of radiation sessions anticipated for each patient.

Private health insurance

The individual patient’s insurance contract specifies the terms applying to holders of private health insurance. An important note: insurance companies are generally required to pay for therapies such as photon radiation, particularly in light of the decision issued by the Federal Supreme Court of Germany on 3/12/2003 (AZ IV Z R 278/01). Patient Management will give you a cost estimate and a medical necessity letter to submit to your insurer. Please do not hesitate to contact Patient Management if you have any questions.

Self-Paying Patients

For patients paying for their own treatment, an individual cost estimate is generated based on the number of radiation sessions anticipated. Payment must be made prior to the first treatment session.

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