Can a statutorily insured patient call a private doctor?

What is legally allowed and economically sensible

German law places no restriction on which doctor a patient may see. As a statutorily insured patient (GKV) you may call a private doctor at any time — for normal consultations, house calls or second opinions. The medical code of conduct explicitly permits it. The decisive point is billing: in that situation you act as a self-payer, not as a statutory patient. The private doctor bills you directly under GOÄ; the statutory fund does not reimburse such bills (with narrow exceptions under § 13 (3) SGB V for genuine emergencies with no contracted physician available).

Economically the private route makes sense for GKV patients in several situations. First: you hold supplementary private insurance with a private-doctor or ambulatory option — then this insurance covers the bill (typically up to factor 2.3 or 3.5). Second: you want to avoid the long 116117 wait times (4 to 8 hours in Berlin) and are willing to pay for speed. Third: you have specific needs — English-speaking doctor, hotel visit, discretion, house call outside practice hours — that are hard to arrange via the GKV system.

Importantly, your GKV membership remains unaffected by using a private doctor. You are not 'double-insured' and no reporting is needed. The sick-note, prescription and all medical documents you receive from the private doctor are legally valid — for your employer, your pharmacy and your statutory fund. You can keep the invoice and claim it on your tax return as exceptional medical expenses (above the standard threshold). On the phone we give honest guidance: if 116117 or your regular GP would be the more sensible route, we say so clearly.

Example: self-paying mother in Pankow

A GKV-insured mother in Pankow has a two-year-old with high fever and otitis media. It is Saturday morning, her GP is closed, 116117 quotes a six-hour house-call window. She deliberately chooses the private route: the doctor arrives within 70 minutes, examines the child, confirms otitis media, prescribes antibiotic and pain relief, issues a certificate. Invoice 270 euros, borne as a self-payer. She files the bill with other medical receipts for her tax return.

When the private route makes sense

• With supplementary private insurance (private-doctor tariff): the bill is reimbursed — economically neutral.
• Long 116117 wait times (4 – 8 hours in Berlin) unacceptable — deliberate self-pay for fast help.
• Specific needs: English-speaking care, hotel visit, discretion, house call outside practice hours.
• Mobility-impaired patients without GP house calls — private doctor as a practical alternative.
• Pure emergency without contracted physician availability: claim under § 13 (3) SGB V possible, outcome uncertain.
• Tax-deductible as exceptional medical expense — bundle all medical receipts of the year.
• Sick-note, prescription, hospital referral from the private doctor are legally valid — including with GKV authorities.
• No consequences for GKV membership — no switch, no notification needed.