Sometimes, when you are sick, you need to see a specialist (such as an orthopedist, a surgeon, etc.), but often you have to go to your family doctor first to request a medical prescription (Überweisung). In these cases, the question will be: should you always go to your family doctor first or can you go directly to the specialist?
The answer is: it depends on the situation.
In Germany, you don’t have to go to your family doctor first, you can simply go to a specialist. However, there are some restrictions to be observed:
- If you are insured with a public insurance company (e.g. AoK), you will need to see a specialist who has an agreement with the public insurance company, otherwise the cost of the medical service will not be covered by the policy and you will have to pay out of your own pocket;
- If you are insured with a public insurance company, you will always have to go to the family doctor and request a prescription before seeing a specialist. There are some exceptions for: gynecologist, ophthalmologist, pediatrician, dentist, emergency treatment.
The family doctor will issue a medical prescription for seeing a specialist only if he considers it medically necessary. When and how an Überweisung is to be issued is regulated in the so-called “Manteltarifvertrag Ärzte” (an agreement between the Federal Association of Medical Examiners and the Central Association of State Health Insurance Funds).
Going to the family doctor for an Überweisung can also be a good thing
Going first to the family doctor for a medical prescription is not just a waste of time; in many cases it provides benefits that should not be underestimated:
- it is used as a means of communication between the family doctor and the specialist;
- it is often accompanied by several other information (Überweisungschein) with which the patient’s past complaints and diagnoses and/or the results of previous tests are communicated. All this information helps the specialist to formulate the correct diagnosis and determine the most appropriate treatment.
For all other specialized areas that require the use of very expensive machinery and highly qualified staff, the Überweisung of the family doctor is always necessary, as you cannot see directly a specialist just because you have general pains. We refer in particular to specialists in: laboratory medicine, nuclear medicine, radiology, radiotherapy, microbiology and epidemiology of infections, pathologists, transfusion medicine. Except for mammography, which is considered as prevention and can be carried out without the obligation of the general practitioner.
There are different types of medical prescriptions
In Germany, there are different types of Überweisung:
- Auftragsüberweisung. The specialist is asked to carry out certain examinations and, based on the results of the tests carried out, provide a second opinion. The treatment is carried out at the referring doctor;
- Überweisung zur Konsiliar-Untersuchung. A collegial specialist medical consultation is required for diagnostic purposes. This is a special form of Auftragsüberweisung;
- Überweisung zur Mitbehandlung. The specialist doctor will be involved in the treatment because the case goes beyond the competence of the general practitioner;
- Überweisung zur Weiterbehandlung. The referring doctor renounces treatment completely – for professional reasons, sometimes also due to changed circumstances of the patient (e.g. change of clinical picture of the patient, transfer of the patient to another city, etc.);
- Beauftragung einer Laboruntersuchung. Laboratory tests are required. However, diagnosis and therapy remain the responsibility of the treating doctor.
Do privately insured persons need to see a family doctor first?
People whit a private health insurance are not obliged to go first to family doctor and ask for a medical prescription, they can consult a specialist of their choice at any time. However, the medical necessity of a treatment is an important prerequisite for the reimbursement of the costs by the insurance.
Some private insurances offer their clients the so-called “Primärarzttarife” (primary doctor rates, the primary doctor it is very often the family doctor)). In this case, the initial treatment must first be carried out by the family doctor. Specialist costs are only reimbursed (in full) if the family doctor considers it necessary to consult a specialist and in these case it will always be necessary to have an Überweisung issued by the primary doctor.
For how long is a medical prescription valid?
The doctor’s Überweisung is always valid until the end of the respective quarter. For example, if it was issued on 2 January or 12 February, it will only be valid until 31 March. However, medical centers accept very often the medical prescriptions even at the beginning of the following quarterly period, especially if the prescription was made almost at the end of the previous quarter.