What is a private clinic? A hospital that as a rule has no statutory health insurance accreditation and therefore bills privately, either directly with the patients or with their private health insurance (PKV). Whether your PKV covers the costs is set out in your tariff. Even as a privately insured patient, you do not automatically get reimbursed for every clinic, and some tariffs require advance approval for private clinics.
The key points in brief
- A private clinic usually has no contract with the statutory health insurers and bills privately.
- Reimbursement depends on the tariff: some tariffs pay for any clinic, others only for accredited hospitals or only after approval.
- For inpatient treatment, the hospital and the insurer generally bill each other directly.
- You can submit doctors’ bills within three years from the end of the year in which they were issued.
- Statutorily insured patients generally bear the costs of a private clinic themselves, unless the health insurer approves them in advance.
What is a private clinic?
A private clinic is a privately run hospital that is not, or only partly, integrated into the care of statutorily insured patients. Patients treated there either pay themselves or have the bill reimbursed by their private health insurance.
Typical examples are clinics with a narrow specialty, such as orthopaedics, oncology, psychosomatics or plastic surgery. Rehabilitation clinics and specialist centres for individual procedures also belong to this group. In everyday usage, the term “private clinic” is not sharply defined. What matters for you is whether the clinic bills the health insurers and whether your tariff covers it.
What is the difference between a private clinic and a hospital?
A general hospital (Plankrankenhaus) is listed in the hospital plan of the respective federal state and treats both statutorily and privately insured patients. A private clinic is generally not on this plan and has no supply contract with the health insurers. The table gives an overview of the differences.
| Feature | General hospital | Private clinic |
|---|---|---|
| Integration into statutory care | Yes, services for statutorily insured patients are provided | As a rule, no |
| Billing | With the health insurers, and for privately insured patients with the insurer | Privately, with the patient or the insurer |
| Statutorily insured patients | Treated within the scope of statutory benefits | Generally pay themselves |
| Privately insured patients | Reimbursement according to the tariff | Reimbursement according to the tariff, in some cases only with approval |
What belongs to the scope of a tariff in a normal hospital, such as room category and treatment by the chief physician, is explained in private health insurance and hospital stays (in German).
What is a Belegarzt?
A Belegarzt is a self-employed doctor who treats their own patients in a hospital and uses its beds, operating theatres and nursing staff for this. They are not employed there but bill their medical services themselves.
Belegärzte work in general hospitals and in some private clinics. For you as a privately insured patient, this means two bills may arise: one from the doctor and one from the hospital. Ask before the procedure who bills what, and have both items confirmed by your insurer.
What does a private clinic cost, and what does the PKV pay?
There is no fixed price. The costs depend on the procedure, the clinic and the length of stay. A flat sum would therefore be misleading. Before a planned procedure, ask the clinic for a cost estimate.
The bill usually consists of two parts. Medical services are billed under the fee schedule for doctors (GOÄ). For personal medical services, the threshold value is 2.3 times the basic rate and the maximum rate is 3.5 times. Above the threshold value, the doctor must justify the higher rate on the bill. Above the maximum rate, a written fee agreement under § 2 GOÄ is needed before treatment. In addition, the clinic bills accommodation, nursing and the operating theatre, either as a flat rate or as a daily rate, depending on the clinic. An overview of the fee schedule is provided by the Federal Agency for Civic Education.
How much of this your PKV reimburses is set out in the tariff. These building blocks are common:
- Free choice of hospital, including clinics without statutory accreditation
- Reimbursement only for hospitals with statutory accreditation
- Private clinics only after written approval from the insurer
- Limitation to the costs that would have arisen in a comparable hospital
Example (freely chosen figures, for illustration only): a private clinic bills €10,000 for a procedure. The tariff reimburses private clinics only up to the costs of a comparable hospital, and the insurer sets €6,000 for this. This leaves €10,000 minus €6,000 = €4,000 as your own share. If the tariff allows free choice of clinic without a cap, the insurer covers the medically necessary costs within the terms of the tariff.
How does private billing in hospital work?
Privately insured patients generally pay their doctors’ bills first and submit them to the insurer. For an inpatient stay, however, this is different: the hospital usually bills the insurer directly. In practice, it works like this:
- Before admission, ask your PKV whether the clinic is covered by your tariff, and request the approval in writing.
- At admission, check which optional services you agree to, for example chief physician treatment or a single room.
- After the stay, compare the clinic bill and the doctors’ bills with the insurer’s reimbursement statement.
- Submit bills you have paid yourself to the insurer. You can do this within three years from the end of the year in which the bill was issued. A bill from March 2026 can therefore be submitted until 31.12.2029.
What applies to statutorily insured patients?
In statutory health insurance (GKV), you are normally treated in a hospital that has a contract with the health insurers. There you currently pay a co-payment of €10 per calendar day for up to 28 days. Higher co-payments have been decided for 2027. A private clinic without statutory accreditation would in principle have to be paid for by you. Clarify with your health insurer before admission whether it covers anything in your individual case.
Whether the free choice of clinic justifies a switch to PKV should be weighed carefully. The exemption from compulsory insurance applies for the entire course of study and cannot be revoked. A return to statutory insurance is difficult afterwards, and PKV premiums can rise. The consumer advice centre describes the options for students in an overview.
What should you look for in your tariff?
These four questions will help you check. Read the tariff conditions in the section on inpatient treatment, or ask your insurer to explain them.
- Is the choice of hospital free, or is it limited to hospitals with statutory accreditation?
- Does a private clinic need approval in advance, and in what form?
- Are the costs limited to those of a comparable hospital?
- Are chief physician treatment and a double or single room included?
Which other areas a tariff regulates is shown in the overview of what private health insurance covers for students (in German).
Frequently asked questions
Does PKV pay for every private clinic?
No. It depends on the tariff. Some tariffs reimburse treatment in any hospital, others only in hospitals with statutory accreditation, or only after the insurer has approved them. If you obtain the approval in writing before the procedure, you can avoid disputes over the bill.
What does private billing in hospital mean?
Private billing means that services do not run through the health insurers, but are billed to you or your private insurer. Medical optional services such as treatment by the chief physician are billed by the doctor under the GOÄ. For inpatient stays, the bill generally goes directly to the insurer.
Can I go to a private clinic as a statutorily insured patient?
You can be treated there, but in principle you bear the costs yourself. A private clinic without statutory accreditation does not bill the health insurer. Ask your health insurer before admission whether it covers anything in your case, and get the answer in writing.
How long can I submit a clinic bill to the PKV?
The deadline is three years and begins at the end of the year in which the bill was issued. A bill from March 2026 can be submitted until 31.12.2029. Still, submit promptly so that any queries from the insurer can be resolved while the documents are still available.
So what should you do now?
- Check the tariff conditions on hospital choice and private clinics.
- For planned procedures, obtain written approval from the insurer and a cost estimate from the clinic.
- Clarify whether a Belegarzt is involved and who issues which bill.
- Keep all bills and reimbursement notices, and observe the submission deadline.
- If you want to talk through your situation, you will find the way to a consultation on the Academycon homepage.
You can find experiences with us on ProvenExpert, Trustlocal and Trustindex. Academycon was also mentioned in a report by VersicherungsJournal. An overview of all mentions is on the press page (in German).
Related articles
- Doctor’s appointments as a privately insured patient (in German)
- Medicines in private health insurance (in German)
- Insurance for students: an overview (in German)
Last updated: October 2026. This guide is general information, not individual advice. The German version is authoritative.
