IGeL services: A guide for physicians and patients

"Unfortunately, the health insurance company does not cover this service" - this is what patients hear again and again when they ask for additional preventive, early detection or cosmetic measures. This is because it is highly likely that the requested treatment is a so-called "IGeL service" that the patient has to pay for out of his or her own pocket.

What are IGeL services?

The abbreviation "IGeL" stands for "individual health services. These are diagnostic and therapeutic methods or services that patients take advantage of voluntarily at their own expense. Doctors are happy to advise patients in these cases and also suggest additional services themselves if they consider them useful. However, the decision for or against additional treatment ultimately lies with the patients, of course.

This is why individual health services are not covered by health insurers

IGeL services are not considered medically necessary and are therefore not included in the benefits catalog of the statutory health insurers. For the corresponding health services to be included in the benefits catalog, they must be reviewed by the Federal Joint Committee (G-BA) for quality and effectiveness according to the latest scientific findings. Only then can the services be billed via the insurance companies.

Who offers self-pay services?

Most physicians, dentists and psychotherapists offer additional services to varying degrees. The reasons for this are different:

Only very few healthcare providers exclude additional services as a matter of principle. This is because the German Medical Association also considers IGeL to be "justifiable services" whose performance is at the discretion of the practitioner.

These IGeL services are available

The range of self-pay services is very large. However, there is no binding list. Patients can make use of additional services in virtually every specialist area. The "most popular" IGeL services include:

• Intraocular pressure measurement (early glaucoma detection)
• Ultrasound examinations of the chest and abdomen
• PSA test (prostate cancer screening)
• Tattoo removal
• Travel vaccinations

Since not all IGeL are low-risk, a detailed explanatory discussion should always take place before the procedure is performed.

Here's what you should look for as a doctor when consulting on individual health services

Benefits, risks and costs: There is a lot to consider when it comes to IGeL so that patients can make an informed decision. The doctor-patient discussion is essential for this.

This is how you can point out IGeL to patients

There are a number of ways you can make your patients aware of the additional services you offer.

Caution: Strict laws apply to additional health services. As a rule of thumb, you may advertise for IGeL services, but you must inform your patient primarily about the treatments that are covered by his or her health insurance. Under no circumstances may you force an IGeL service on your patient! In case of doubt, specialized lawyers will be happy to advise you on this topic.

Information on the web: Homepage, Social Media and Co.

In the digital age, it makes sense to use the practice homepage, social media channels or your profiles on physician portals to draw attention to your service portfolio. Younger patients in particular often obtain information on the Internet before deciding on a practice. A meaningful online presence can therefore be the decisive factor that sets you apart from the competition.

Inform analogously with flyers and in conversations

Of course, you can also draw attention to your services in the same way. For example, by displaying flyers with information about your services in the practice rooms. The patient interview itself should not be underestimated! In a personal exchange, you can not only point out IGeL services directly, but also respond individually to questions.

Tips for the patient interview

It is not always easy to talk to patients about individual health services. After all, doctors are reluctant to be perceived as salespeople. A commercial appearance can not only have a negative impact on the course of the conversation, but also put a lasting strain on the relationship of trust. The focus of your IGeL consultation should therefore always be the patient's individual situation and the advantages and disadvantages of the medical service. In this way, you enable your patient to make a free, informed and individual decision for himself and his health.

Guideline for patient discussions about self-pay services

The National Association of Statutory Health Insurance Physicians (Kassenärztliche Bundesvereinigung) provides physicians with specific tips for doctor-patient communication on the topic of IGeL services. These include, among others:

1. Explain to your patients why the service is advisable from a medical perspective.
2. Inform your patients in an understandable way about existing scientific evidence for the benefits of the service.
3. Explain the risks and side effects of the service.
4. Keep the conversation non-promotional and advise without sales intent so your patients don't feel pressured.
5. Provide more information to your patients.
6. Point out to your patients that they are allowed to think about the offer at their leisure and do not have to decide immediately.
7. Explain the specific process from the written treatment agreement to implementation and billing. This way, your patients know which steps take place at which point in time.
   

Tip: For more information, visit the site of the National Association of Statutory Health Insurance Physicians.

As a patient, you should be aware of the following with regard to IGeL services

It is important that you as a patient weigh up the individual benefits and risks of an IGeL service before treatment. Your attending physicians will advise you in detail from a medical point of view.

Here you can find information on the Internet

If you want to do more research on IGeL services than just talk to your doctor, the Internet is a good place to start. However, not all websites are reputable and independent. One trustworthy source is the IGeL Monitor of the German National Association of Health Insurance Funds. There you will find an overview of popular self-pay services that have been evaluated by experts according to their potential benefits and possible risks.

Tips for the doctor's consultation

Analogous to the guide for physicians, the National Association of Statutory Health Insurance Physicians has also compiled tips for patients. These will help you to recognize whether you are being well advised. After all, an informative discussion with the doctor without a promotional character is important for your decision-making.

The physician interview should meet these quality criteria:

Tip: The detailed IGeL checklist for patients can be found at the Kassenärztliche Bundesvereinigung.

Treatment contract and invoice: This is what matters

If you offer or use an IGeL service, both a written treatment contract and an invoice are mandatory.

This is what the treatment contract says

The treatment contract is concluded between the doctor and the patient before the IGeL service is performed. Irrespective of the service in question, it must contain the following points:

• Concrete performance description
• Estimate of costs according to the scale of fees for physicians
• Declaration that the service is desired from the patient side
• Declaration that the service is not a service provided by a panel physician
  

Fee framework for IGeL invoices

The formal requirements for IGeL billing are governed by the physician fee schedule. Here, fixed fee limits are specified for each service. If the invoice amount differs from the estimated amount in the treatment contract, you as the patient should ask and have the difference justified!

How to bill for individual health services!

For many physicians, it is primarily a bureaucratic challenge: the billing of IGeL services. Since they are not paid for by the health insurance company, but by the patients themselves, adjustments to the billing process are necessary. After all, the process should be as efficient as possible for both sides. This is where Nelly's software comes in, enabling you to bill self-pay services in a particularly simple and user-friendly way.

Accounting made easy with Nelly

No special knowledge is required for Nelly, as the billing process is very simple with three steps:

1. Your patients choose the payment method directly on their own smartphone.
2. Nelly encrypts the data according to the highest security standards.
3. The billing is automatically intiated by Nelly.

Create a digital workflow in your practice now. We will advise you on your individual case without obligation and free of charge!  

Contact Nelly now!

The personal designations used in this article always refer equally to all persons. For the sake of better readability, we do not use the same name twice or in the opposite gender.

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