If you choose a chief-physician treatment or a two-bed room in a German hospital, you receive a private doctor’s billing, known as a Wahlleistung. Statutory health insurance does not cover these optional services. This guide explains what the agreement contains, when you should sign it, and what to check on the bill.
Short answer: Private billing (privatärztliche Abrechnung) means that an optional-service physician, usually the chief physician, bills your treatment under the German fee schedule for physicians (GOÄ). You need a written agreement with the hospital. Statutory health insurers do not cover these services. Private insurance pays only if your tariff includes them. Last updated: October 2026.
The Most Important Points
- Optional hospital services are voluntary. Without an agreement you receive the hospital’s standard services.
- The agreement must be in writing and signed by you and by the hospital.
- Statutory health insurers do not cover these services. In private insurance (PKV), the insurer pays only if your tariff includes them.
- The agreement is not urgent. If pain or medication prevents you from deciding clearly, do not sign.
- If the chief physician does not treat you and a senior doctor (Oberarzt) takes over, the agreement can be void, according to a Federal Court of Justice ruling.
What Are Optional Services in a German Hospital?
Optional services fall into three groups. Accommodation includes single or two-bed rooms and extras such as internet, television or a choice of meals. A single room is not an optional service if it is medically necessary. Physician services (ärztliche Wahlleistungen) mean treatment by the chief physician or another optional-service doctor, who must personally perform the service. Medical optional services (medizinische Wahlleistungen) are treatments without medical necessity, such as certain cosmetic procedures, extended laboratory tests or new methods.
| Type of optional service | Examples | Statutory health insurance | Private insurance |
|---|---|---|---|
| Accommodation | single room, two-bed room, choice of meals | does not cover | depends on tariff |
| Physician service | treatment by the named chief physician | does not cover | depends on tariff |
| Medical optional service | procedures without medical necessity, new methods | does not cover | depends on tariff |
Source for the classification and the cost coverage: Verbraucherzentrale (German consumer advice centre), as of 3 April 2025.
When Should You Sign the Optional Services Agreement?
The agreement is a written contract with the hospital. It becomes effective only once you and the hospital or the doctor have both signed it. A signature from you alone is not enough. Charges start only from the date of signature, and backdating is not possible, according to the Verbraucherzentrale.
The consumer advice centre stresses that the agreement is not urgent. You do not have to sign in an emergency and can conclude it later, once you are able to decide. Do not sign if severe pain or sedation prevents clear decisions.
Why Does the Chief Physician Matter?
If you book a chief-physician treatment, you expect the named doctor to perform the service personally. On 13 March 2025, the Federal Court of Justice (Bundesgerichtshof, case III ZR 40/24) ruled on this. If an Oberarzt substitutes for the chief physician, the agreement can be void under this ruling, as the Verbraucherzentrale summarises.
Check beforehand who will actually perform the treatment, and have this confirmed in the agreement. If you are unsure at admission, ask at the information desk or the administration. A helpful guide for students is chief-physician treatment for students (in German).
How Do You Read the Bill Correctly?
Bills for physician services follow the German fee schedule for physicians (Gebührenordnung für Ärzte, GOÄ). Each fee results from a point value multiplied by a so-called Steigerungsfaktor (fee multiplier). The bill lists each service with its number, multiplier and amount. These entries should match the agreement and the course of treatment.
You may ask to see the fee schedule and raise questions about the bill. Check whether all items fit your treatment, whether the named doctor was actually involved and whether the agreement date comes before the treatment. If something looks wrong, the consumer advice centre is a good contact.
Bring your insurance card and the documents of your tariff to the hospital. If you have private insurance, ask your insurer before admission to confirm which optional services your tariff covers. Note the names of the doctors involved and the administrative contacts. After discharge, the hospital issues the bill, which you should check before you pay it or submit it to your insurer. Many insurers require the original bill together with a reimbursement claim. Keep the agreement, the bill and all correspondence together so that you have everything at hand if questions arise.
What Does Private Health Insurance Pay?
In private health insurance, the insurer reimburses optional services only if they are included in your tariff. A chief-physician treatment or a two-bed room is often a separate module. Check the tariff before you agree to any optional service. Reimbursement follows the contract, not what is customary.
If you are statutorily insured, the health fund does not reimburse optional services. A supplementary policy can cover them, but only if its contract provides for it. Our guide on PKV coverage during hospital stays (in German) lists what private insurance covers in hospitals.
Frequently Asked Questions
Do I have to take an optional service when I go into hospital?
No. Optional services are voluntary. Without an agreement you receive the hospital’s standard services, and treatment by the doctor responsible for your care continues.
Can I reject a signed agreement later?
A signed agreement binds you as long as it is effective. Whether it is effective depends on the individual case, for example on whether the chief physician performs the service personally. If in doubt, the consumer advice centre or a lawyer specialising in medical law can help.
Does public health insurance pay for optional services for civil servants?
The consumer advice centre does not address this question in its guide. Ask the responsible state aid office (Beihilfestelle) before you agree to an optional service.
How do I recognise an incorrect bill?
Compare the items with the course of treatment, the date and the agreement. Make sure the named doctor performed the service. If in doubt, have the bill explained before you pay it or submit it to your insurer.
What Should You Do Now?
- Read the optional services agreement carefully before you sign, and ask what exactly is charged.
- Clarify which doctor will actually perform the treatment and have this commitment confirmed in writing.
- If you have private insurance, check whether your tariff reimburses the optional services you choose.
- Check the bill by item number, multiplier and date before you pay or submit it.
Related Reading
- Five important hospital benefits in student PKV (in German)
- Benefit statements in PKV: how to read bill and reimbursement (in German)
- Public or Private Health Insurance for International Students
Sources: Verbraucherzentrale, Optional services in hospitals: what you need to know (as of 3 April 2025, in German); Fee schedule for physicians (GOÄ), Laws on the internet (in German).
Last updated: October 2026. This guide is general information, not individual advice.
