Statutory health insurance (GKV) covers the costs of psychotherapy if three conditions are met: The psychotherapist must be registered with a health insurance fund; the Associations of Statutory Health Insurance Physicians grant this registration and maintain a list of addresses. The diagnosis must be considered a medical condition, and the treatment method must be recognized. Recognized methods include behavioral therapy, depth psychology-based psychotherapy, analytical psychotherapy, and systemic therapy. You do not need a referral from your primary care physician.
In private practices, psychotherapy may also be covered by statutory health insurance (GKV) through the reimbursement process.
Psychotherapy Appointments
Each treatment session is preceded by a consultation lasting at least 25 minutes. This consultation serves as an initial assessment: Are there any disorders that require treatment? What are the primary symptoms? Is psychotherapy the appropriate course of action? Which approach is suitable? You can schedule an appointment directly with any psychotherapist who accepts health insurance or by calling 116117.
At the end of the session, the psychotherapist fills out Form PTV 11. It includes the findings and recommendations. If treatment is needed promptly, this is also noted on the form, along with a referral code. This code is the key to the next step.
What Happens After the Appointment
There are three possible scenarios.
In the best-case scenario, the therapist has availability. In that case, you can schedule trial sessions directly, without going through the appointment scheduling service.
The second scenario is more common: You receive a PTV 11 form with a referral code because you need psychotherapy promptly, but the psychotherapist has no openings. This gives you a legal right: the appointment service must arrange an initial trial session within four weeks. If the rapport isn’t right, you’re entitled to a second referral. No more than two guaranteed referrals are provided. You can then arrange any additional trial sessions directly with the psychotherapists.
The third scenario: The psychotherapist does not recommend psychotherapy. Other forms of assistance are more appropriate: counseling, rehabilitation, self-help. The recommendation specifies which forms of assistance are appropriate. In this case, the PTV 11 does not include a referral code.
Trial Sessions and Therapy Application
Two to four preliminary sessions precede the actual therapy. They serve the purposes of diagnosis, planning, and getting to know one another. Afterward, the psychotherapist needs a consultation report from a physician who rules out any physical causes. Only then is the application submitted to the health insurance provider.
For short-term therapy consisting of up to 24 sessions, no medical evaluation is required; the health insurance provider will respond within three weeks. For applications for long-term therapy, the health insurance provider usually commissions an external expert to decide whether to approve the treatment. The response time is up to five weeks. If no response is received by the deadline, the psychotherapy is considered approved.
If there is no PTV 11 with a referral code
Without PTV 11 or the note „required promptly,“ a referral via 116117 is not possible. In this case, please contact the practice again: It may be possible to add this information to the form retroactively. If the psychotherapist stands by their assessment, continue your search on your own—online, by phone, or by email.
The 116117 System
The 116117 Appointment Service Center is accessible nationwide by phone, through eterminservice.de, and via the app. It arranges three types of appointments: consultations without a code, emergency treatment, and probationary sessions. For the latter two, you’ll need a PTV 11 with a referral code. You can also contact a psychotherapy practice directly to schedule a consultation.
In conversations with my patients, it has become clear that the counselors at 116 117 have very varying levels of knowledge. It’s therefore worth taking the time to learn about the process and your rights first. That’s exactly what you’re doing right now.
The guaranteed timeframes: consultation within four weeks, preliminary session within four weeks, acute treatment within two weeks. If an outpatient appointment cannot be scheduled, a hospital appointment must be arranged within five weeks.
116117 assigns you an available appointment. You have no say in who is assigned to that appointment. However, among the three therapists you might see there, there’s usually someone you’ll like.