Emergency room costs with private insurance work differently from statutory insurance. Anyone who is privately insured and goes to the emergency room is treated first, and the question of costs is settled afterwards. In an emergency you dial 112, and billing runs later through your policy: you receive the invoice, pay it first and submit it to your insurer. For inpatient treatment, the hospital usually bills your insurer directly.
Key takeaways
- Privately insured patients pay doctors’ invoices first and are then reimbursed by the insurer according to their tariff.
- For inpatient treatment, direct billing between the hospital and the insurer is the rule.
- Doctors bill under the scale of fees for medical practitioners (GOÄ). Above the maximum rate, a fee agreement is ruled out in emergencies.
- You can submit invoices within three years from the end of the year in which they were issued.
- What the insurer reimburses for ambulances and patient transport is set out in your tariff conditions.
What happens in the emergency room if you are privately insured?
In an emergency, treatment comes first and billing follows. You receive medical care in the emergency room, are admitted as an inpatient if needed, and only receive the invoice after treatment.
It is important to keep your documents: discharge letter, invoices and payment receipts. With them you can later show clearly what the insurer should reimburse.
Who pays emergency room costs with private insurance?
Reimbursement comes through your insurer, but via a detour. The principle of reimbursement applies: you pay the doctor’s invoice yourself first and submit it to the insurer. There is no direct contractual relationship between the doctor and the insurer. The amount reimbursed depends on your tariff, that is, on the percentages and maximum amounts agreed there.
With inpatient treatment it works differently: direct billing between the hospital and the insurer is the rule. How the emergency department of a hospital bills in an individual case can vary. If in doubt, ask at reception. You will find more on the scope of benefits in our overview of private health insurance benefits (in German).
What does the doctor’s invoice say after an emergency?
Private medical services are billed under the GOÄ. The single rate results from the number of points multiplied by the point value of 5.82873 cent. The doctor then applies a multiplication factor, which has to be set within the range at their reasonable discretion.
| Type of service | Threshold value | Maximum rate |
|---|---|---|
| Personal medical services | 2.3 | 3.5 |
| Medical-technical services | 1.8 | 2.5 |
| Laboratory services | 1.15 | 1.3 |
Up to the threshold value, the doctor does not need to give a reason. Above it, they must justify each service in writing on the invoice, relating it to the patient, the illness or the circumstances. Generic justifications are not enough. If the doctor wants to bill beyond the maximum rate, a written fee agreement under § 2 GOÄ is required before treatment begins. Such an agreement is ruled out for emergencies and acute pain treatment. A reform of the GOÄ is planned; until a new regulation applies, the existing one remains in force. The Federal Agency for Civic Education (bpb) explains the details.
How and by when do you submit the invoice?
You can submit invoices within three years from the end of the year in which they were issued. Example: an invoice from March 2026 must be submitted by 31.12.2029 at the latest. Still, do not wait that long, because over time it becomes harder to reconstruct documents and treatment sequences.
Note also that some tariffs provide for a premium refund if you submit no invoices for a year. Submitting an emergency invoice may cause this refund to lapse. For larger invoices it is usually still worthwhile to submit them; for small amounts, it is worth doing the calculation first.
What do an emergency doctor and an ambulance cost if you are privately insured?
How high the costs are and what share is reimbursed depends on your tariff. Whether it is an ambulance journey, an emergency doctor call-out or patient transport: your insurer’s conditions set out what is covered and whether maximum amounts apply.
The differences between an ambulance and patient transport, and what to look for in your tariff, are explained in our article on patient transport in private health insurance (in German).
How does this differ from statutory health insurance?
People with statutory insurance generally receive benefits in kind. In addition there are co-payments: in hospital they amount to 10 euros per calendar day for up to 28 days (as of 2026), and higher co-payments have been agreed for 2027. Health insurers only cover patient transport and transport to treatment where medically necessary and prescribed.
| Feature | Statutory (GKV) | Private (PKV) |
|---|---|---|
| Billing with the doctor | Usually as a benefit in kind | Invoice that you pay and submit yourself |
| Billing in the hospital | Between hospital and health insurer | Direct billing with the insurer is the rule |
| Scope of reimbursement | Statutory framework | According to tariff |
Do trainees (Referendare) have to be privately insured?
No, there is no general obligation to take out private insurance. Trainee civil servants are usually civil servants on probation. They arrange their own health and long-term care insurance, either privately or voluntarily through statutory insurance, and receive supplementary Beihilfe (state aid). Depending on the federal state, trainee lawyers (Rechtsreferendare) are either civil servants on probation or in a public-law training relationship. In a training relationship, statutory health insurance is compulsory and there is no entitlement to Beihilfe.
Which case applies to you is stated in your appointment notice. We summarise the details in our article on health insurance during the trainee period (in German).
What applies to emergency treatment abroad?
Whether and to what extent your tariff pays abroad is set out in the tariff conditions. Before every trip, check whether the cover for overseas treatment matches the duration and destination and whether medically necessary repatriation is included. Statutory insured persons use the European Health Insurance Card within the EU, which does not cover repatriation to Germany. Studying abroad follows its own rules, which we explain in health insurance during a semester abroad (in German).
Frequently asked questions
Do I have to pay for the emergency room myself if I am privately insured?
At first, yes, if the doctor issues you an invoice. You then submit it to your insurer, which reimburses according to your tariff. With inpatient treatment, the hospital usually bills your insurer directly. Ask at admission how your case is handled, so that you do not overlook any advance payment.
Can the doctor charge more than the maximum rate in an emergency?
Not without a fee agreement. Beyond the maximum rate, a written fee agreement under § 2 GOÄ is required before treatment begins. In emergencies and acute pain treatment it is ruled out. Between the threshold value and the maximum rate, the doctor must justify each service in writing and in relation to your case; generic justifications are not sufficient.
How long do I have to submit an emergency invoice?
You can submit the invoice within three years from the end of the year in which it was issued. An invoice from March 2026 can therefore be submitted by 31.12.2029. Tip: submit it promptly while documents and the treatment sequence are still fresh.
Does private health insurance pay for the ambulance?
That depends on your tariff. Check the conditions to see which costs for ambulance journeys, emergency doctor call-outs and patient transport are reimbursed and whether maximum amounts apply. If in doubt, ask your insurer before a trip or a planned hospital stay.
How to proceed now
- Read your insurer’s tariff conditions on emergency services, patient transport and cover abroad.
- After an emergency, keep all invoices, receipts and discharge letters.
- Submit larger invoices promptly and keep the three-year deadline in mind.
- Check on the invoice whether any multiplication factors above the threshold value are justified in writing.
- If you want to discuss your situation, you will find the way to advice on the Academycon homepage.
You can find reviews of us on ProvenExpert, Trustlocal and Trustindex. Academycon has been mentioned, among other places, in a report in the VersicherungsJournal. An overview of all mentions is on our press page (in German).
Related reading
- Private health insurance benefits for students: an overview (in German)
- Private insurance and dental benefits: what students get covered (in German)
- Naturopathic treatments in private insurance: what is reimbursed (in German)
- Private insurance in hospital: what inpatient cover provides (in German)
Last updated: October 2026. This guide is general information, not individual advice. The German version is authoritative.
