Do you hedgehog?

The world of acronyms is big: terms formed from the first letters of individual words are appearing more and more frequently. “IGeL” is such an acronym. And in this case neither the “interest group of the labyrinth fish” nor the “Institute for holistic learning” or any other institution is meant. “IGeL”  is the acronym for  “Individual Health Services” . First of all, this means all diagnostic and treatment options that are not covered by statutory health insurance companies.

Showing quills or spines?

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

• Travel medical advice and corresponding vaccination advice
• Travel vaccinations
• Suitability tests, for example for travel, fitness to fly, diving
• Sports medicine examinations and advice
• Allergological professional aptitude tests (e.g. baker, hairdresser)
• Medical cosmetic services such as tattoo removal
• Aesthetic  Operations
• Tests to check the compatibility of cosmetics
• Blood group determination on request
• Additional check-ups on request

Lots of useful research

With many IGeL services, it is easy to see why they should not be paid for by health insurance companies, but are still useful. For example, if you want to go on vacation in the tropics, you should definitely have your “tropical suitability” checked by a doctor beforehand. Together with the appropriate vaccinations, you can go on holiday well prepared without having to pay the health insurance company. Vacation is private pleasure – and the right vacation preparation does not fall under the financing task of the health insurance company. The allergological professional aptitude tests, some of which are prescribed by the professional associations, are also useful.

If you want to become a baker, for example, you should have yourself tested for a possible flour dust allergy before starting your career; Hairdressers or bricklayers come into contact with chemicals to which they may have an allergic reaction. That’s why it’s important to get clarification before you start working – and you can do that without having to pay for health insurance. 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 later blindness. This disease goes unnoticed without examination and can no longer be adequately treated in the further stages.

Heal or cash in?

According to a study by the AOK Scientific Institute (WIdO) and the North Rhine-Westphalia Consumer Advice Center, almost a quarter of all insured persons (23.1%) were offered an individual health service. This offer is clearly made to a rather high-income and educated patient base, as the study found out.

For the patient, the situation is often like this:  When talking to the doctor, it becomes clear that faster or even better clarification is possible through additional tests. But these have to be paid for privately. At this point, many patients feel under pressure 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 think about the situation and to obtain comprehensive information. If the doctor’s offer is based on an acute and specific emergency, the costs would be covered by the health insurance company anyway. The German Medical Association also describes the range of IGeL services as a balancing act between “healing and cashing in”, because, in their opinion, statutory health insurance no longer guarantees the necessary medical care in all areas. A revised list of IGeL services is to be presented and discussed at the forthcoming German Doctors’ Day in May 2006 in Madgeburg.

Create your own transparency

Anyone who is offered an “individual health service” in the doctor’s office should accept it as such: an offer that is medically necessary from the doctor’s point of view in the individual case. Anyone who does not understand the meaning and purpose of the proposed investigation should ask specifically and emphatically about the meaning and purpose of the additional investigations.

No doctor may perform and bill an individual service against the  patient’s declared  will. No patient should be forced to make an immediate decision during the examination or the interview. If you have any doubts about the necessity of the proposed investigations, you should seek a second opinion when in doubt. Your 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  must give his consent in writing .

If this declaration of consent is not available, the doctor may not issue an invoice. The invoice amount is based on the fee schedule for doctors (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, if in doubt, ask the medical association.

For patients this means:

• Let us explain to you exactly how you will benefit from the investigation and what consequences you have to reckon with.
• Don’t let yourself be pressured and take your time to make your decision.
• If in doubt, get a second opinion.
• Before making use of it, ask your insurance company why the costs for this service are not covered.

It is fundamentally forbidden to offer such services against invoice that are actually cash register services. If patients are asked by their doctor for private payment with reference to the exhausted budget, the health insurance company and the medical association should be involved. Some patient advice centers are offered by the social association VdK Germany. You can also get information from consumer advice centers.

The Stiftung Warentest has also dealt with the various cancer screening tests and recorded their results in the book “Investigations into early detection.  Cancer  – benefits and risks”. The book can be ordered there directly or through bookshops. The German Medical Association, together with the North Rhine Medical Association, provides information on individual services in a brochure.