Can the private doctor issue a referral to a specialist?

How private referrals work

A referral in the German system is more than a friendly letter — it has administrative and billing functions. For privately insured and self-pay patients the situation is simple: we issue a private referral, the recipient (specialist, clinic, lab) recognises it and treats under private billing. The referral names the complaint, our findings, a concrete question for the specialist and a recommended time frame. You can take it directly with you or pre-announce it at the specialist practice. In practice many specialist practices accept a private referral even when running statutory contracts in parallel — it is a useful appointment-accelerator.

For statutorily insured patients the situation is more nuanced. To bill via the statutory fund, specialists and clinics generally need a referral from a contract doctor — i.e. a doctor with statutory accreditation. A private referral does not permit a specialist to bill the appointment as a statutory service because our practice is not connected to the statutory accreditation system. For you as a GKV member it means: you receive a detailed recommendation from us that the specialist can use medically — but formally you have to obtain the corresponding statutory referral from your statutory GP, otherwise you pay the specialist privately or arrange the contact via the 116117 appointment service. This administrative step is not our fault but a structural consequence of the separation between statutory and private medicine.

What we write in the referral: diagnosis or suspected diagnosis with ICD-10 code, previous investigations and therapies, concrete question (diagnostic clarification, co-treatment, assessment), urgency (routine, accelerated, urgent) and possibly enclosed findings. For emergency indications where the specialist is needed immediately (e.g. suspected stroke, acute eye loss) referral is not the route — 112 or direct hospital presentation is.

Example: suspected pulmonary embolism

A PKV-insured patient in Zehlendorf has had unilateral calf swelling for two days and since this morning pleuritic chest pain with mild dyspnoea. We come for the house call; clinically strong suspicion of DVT with beginning PE; saturation 95 %, vitals stable. This picture does not fit outpatient care but requires immediate imaging. We issue a hospital admission slip for the A&E at Charité Campus Benjamin Franklin (pulmonology focus), call A&E to pre-announce her, and organise ambulance transport. Findings and admission slip go with. Not the route via a specialist referral — at this urgency, hospital admission is the only correct path.

When and how we issue referrals

• Private and self-pay patients: private referral unrestricted to private specialists and (usually accepted) to statutory specialists.
• Statutorily insured: private referral is a medical recommendation, not a statutory voucher — for statutory billing you still need a referral from your statutory GP.
• Contents: diagnosis / suspicion, prior findings, concrete question, urgency.
• We bring the referral as a printed letter or send a PDF afterwards.
• For acute hospital indication (stroke, acute abdomen, severe eye loss) — no referral but 112 or direct A&E.
• For specialised diagnostics (CT, MRI, endoscopy): private referral possible; reimbursement via tariff to clarify.
• Hospital admissions (stationary): we issue an admission slip or accompany you directly to A&E.