“Unfortunately, health insurance does not cover this service” - patients hear this again and again when asked for additional preventive, early detection or cosmetic measures. This is because it is highly likely that the treatment requested is a so-called “IGEL benefit”, which the patient will have to pay out of pocket.
What are IGEL benefits?
The abbreviation “iGEL” stands for “individual health services.” These are diagnostic and therapeutic methods or services that are used voluntarily by patients at their own expense. In these cases, doctors are happy to advise patients and also suggest additional services themselves if they find them useful. In the end, however, the decision for or against additional treatment is of course up to the patients.
That is why individual health benefits are not covered by health insurance
IGEL benefits are not considered medically necessary and are therefore not included in the list of benefits provided by statutory health insurance companies. In order for the corresponding health services to be included in the list of services, they must be provided by Federal Joint Committee (G-BA) for quality and effectiveness according to the latest scientific findings. Only then can the benefits be settled by insurance companies.
Who offers self-payment services?
Most doctors, dentists and psychotherapists offer additional services to varying degrees. There are various reasons for this:
Only very few healthcare providers and generally exclude additional services. This is because the Federal Medical Association also regards iGEL as “justifiable services”, the implementation of which is at the discretion of the practitioners.
These IGEL services are available
The range of self-payment services is very wide. However, there is no binding list. Patients can take advantage of additional services in almost every specialist area. The “most popular” IGEL services include:
- Measurement of intraocular pressure (early diagnosis of glaucoma)
- Chest and abdominal ultrasound scans
- PSA test (early detection of prostate cancer)
- Tattoo removal
- travel vaccinations
Since not all hedgehogs are low-risk, a detailed explanatory discussion should always be held before implementation.
As a doctor, you should pay attention to this when advising on individual health services
Benefits, risks and costs: There are a few things to consider when it comes to iGEL so that patients can make an informed decision. The doctor-patient conversation is essential for this.
This is how you can refer patients to iGEL
There are various ways for you to inform your patients about your range of additional services.
Attention: There are strict laws for additional health benefits. As a rule of thumb, you may advertise IGEL services, but you must primarily inform your patient about the treatments covered by their health insurance. Under no circumstances should you impose an IGEL benefit on your patient! In case of doubt, specialized lawyers will be happy to advise you on this issue.
Information on the web: homepage, social media, etc.
In the digital age, it is a good idea to use the practice homepage, social media channels or your profiles on medical portals to draw attention to your service portfolio. Younger patients in particular often find out more on the Internet before they decide on a practice. A meaningful online presence can therefore be the decisive factor that sets you apart from the competition.
Analogous information with flyers and in conversations
Of course, you can also refer to your services analogously. For example, by displaying flyers with information about your services in the practice rooms. The patient interview itself should not be underestimated either! In a personal exchange, you can not only directly refer to IGEL services, but also respond individually to questions.
Patient interview tips
It is not always easy to talk to patients about individual health services. After all, doctors are reluctant to be perceived as sellers. A commercial presence can not only have a negative impact on the course of the conversation, but can also have a lasting impact on the relationship of trust. Your IGEL consultation should therefore always focus on the patient's individual situation and the advantages and disadvantages of medical services. In this way, you empower your patients to make free, informed and individual decisions for themselves and their health.
Guideline for patient discussions about self-pay services
The Federal Association of Statutory Health Insurance Physicians provides doctors with specific information on doctor-patient communication on the subject of IGEL services. These include:
- Explain to your patients why the service is advisable from a medical perspective.
- Inform your patients in an understandable way about existing scientific evidence of the benefits of the service.
- Explain the risks and side effects of the service.
- Keep the conversation ad-free and give advice without sales intent so that your patients don't feel harassed.
- Provide your patients with more information.
- Remind your patients that they can calmly think about the offer and don't have to make a decision right away.
- Explain the specific process from the written treatment agreement to implementation and invoicing. This way, your patients know which steps are to be taken at what point in time.
Tip: For more information, please visit the website of Federal Association of Statutory Health Insurance Physicians.
As a patient, you should keep this in mind when providing IGEL services
As a patient, it is important that you weigh up the individual benefits and risks of an IGEL benefit before treatment. Your treating doctors will provide you with detailed medical advice.
Here you can find information on the Internet
If you want to research IGEL services beyond the doctor's consultation, the Internet is a good place to go. However, not all websites are reputable and independent. A trustworthy source is the IGEL monitor of the National Association of Health Insurance Funds. There you will find an overview of popular self-pay benefits, which have been rated by experts according to their potential benefits and potential risks.
Tips for a doctor's consultation
In line with the guidelines for doctors, the Federal Association of Statutory Health Insurance Physicians has also compiled information for patients. These will help you to see whether you are receiving good advice. Because an informative medical consultation without an advertising character is important for your decision-making.
The medical consultation should meet these quality criteria:
Tip: The detailed IGEL checklist for patients can be found at the Federal Association of Statutory Health Insurance Physicians.
Treatment contract and invoice: That's what matters
If you offer or use an IGEL service, both a written treatment contract and an invoice are mandatory.
That is in the treatment contract
The treatment contract is concluded between doctor and patient before the IGEL service is carried out. Regardless of the respective service, it must include the following points:
- Specific service description
- Cost estimate in accordance with the schedule of fees for doctors
- Explanation that the patient wants the service
- Declaration that the benefit is not a health insurance benefit
Fee framework for IGEL invoices
The formal requirements for the IGEL bill are regulated by the fee schedule for doctors. Fixed fee ranges are given here for each service. If the invoice amount differs from the estimated amount in the treatment contract, you should inquire as a patient and have the difference explained!
This is how you bill for individual health services!
For many doctors, it is primarily a bureaucratic challenge: the reckoning of IGEL services. Since they are not paid by health insurance but by patients themselves, adjustments to the billing process are necessary. After all, the process should be as efficient as possible for both parties. Nelly's software helps you with this, which allows you to bill self-payment services in a particularly simple and user-friendly way.
Billing made easy with Nelly
No special knowledge is required for Nelly, as the billing process is simply carried out in three steps:
- Your patients choose the payment method directly on their own smartphone.
- Nelly encrypts data according to the highest security standards.
- The billing is automatically initiated by Nelly.
Now you too can create a digital workflow in your practice. Wir advise you without obligation and free of charge to your individual case!
The personal names used in this article always refer equally to all persons. Dual naming and alternate names are omitted in order to improve readability.
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