You may get a second opinion before surgery. Either you hire an expert office or you organize the second opinion yourself.
Katja Kutsch (name changed) was surprised when the oncologist of the Thorax Clinic in Heidelberg told her that his therapy suggestion for her lung cancer costs 350 euros. Excuse me? In return she receives his verdict by letter in her mailbox. She thought that she had the right to obtain a second opinion. That is what is written in the German Code of Social Law (§ 27b SGB V Second Opinion).
Yes, that is absolutely her right. The only trouble is that the health insurance doesn’t have to pay for this second medical opinion. At least not for most diseases. Currently, the costs for second opinions are covered by health insurance only for three interventions: removal of the uterus, tonsil operations and shoulder arthroscopy.
Help with Organization
However, there is a big BUT here. You can call a clinic or doctor of your choice, make an appointment and come by with your records. A doctor will advise you free of charge. Because practice and theory sometimes differ. And, of course, it is better to be well informed before making a medical decision. Your health insurance company also recognizes this.
If you do not want to search for a clinic yourself, you can also hire an expert’s office. The employees of the expert offices – some of them also doctors – make sure that the documents are complete. They also go in search of a suitable specialist and are the point of contact if comprehension questions arise regarding the second medical opinion.
The following table lists the twenty-five largest health insurance companies in Germany. It is indicated for which diseases the second opinion is guaranteed to be covered according to the insurance company’s website and whether employees of an expert office will help you to organize the second opinion.
Help with second opinion from insurance company or expert’s office
| Insurance | Operation/Disease | Help by Expert Office | Insured Persons |
|---|---|---|---|
| Techniker | for back, knee, spinal and hip surgery | No | 10.663.500 |
| Barmer | for back and knee surgery | No | 8.969.500 |
| DAK Gesundheit | for orthopedic interventions | Yes | 5.600.000 |
| AOK Bayern | for cancer, knee surgery | No | 4.563.000 |
| AOK Baden-Württemberg | many specialist areas, e.g. orthopedic interventions and cancer | No | 4.508.600 |
| AOK Plus | for cancer and orthopedic interventions in joints | No | 3.368.000 |
| IKK Classic | for cancer, cardiological interventions and foot, hand, hip, knee, back surgery | No | 3.129.100 |
| AOK Rheinland/Hamburg | many specialist areas, e.g. orthopedic interventions and cancer | No | 3.038.100 |
| AOK Nordwest | for cancer and orthopedic interventions | No | 2.900.000 |
| AOK Niedersachsen | not specified | not specified | 2.858.500 |
| Debeka | many specialist areas, e.g. orthopedic interventions, cancer, psychological Illnesses | No | 2.438.893 |
| AOK Nordost | Orthopedic interventions, cancer and various other specialist areas | No | 1.741.800 |
| AOK Hessen | Orthopedic and cardiological interventions, cancer | Yes | 1.702.200 |
| KKH Kaufmännische Krankenkasse | ENT surgery, heart surgery, cancer, urological interventions and back, hip, knee surgery | No | 1.669.400 |
| Knappschaft | Orthopedic interventions, cancer | No | 1.542.900 |
| AOK Rheinland-Pfalz/Saarland | Orthopedic interventions, cancer | No | 1.202.700 |
| Siemens-Betriebskrankenkasse | Back interventions, cancer | No | 1.061.100 |
| BKK Mobil Oil | Knee, hip, back surgery | No | 1.002.100 |
| Axa | Orthopedic interventions, Rare and chronic diseases | Yes | 798.938 |
| AOK Sachsen-Anhalt | Orthopedic interventions, gynecology | No | 785.000 |
| DKV | many specialist areas, e.g. orthopedic interventions and cancer | No | 741.195 |
| Audi BKK | Knee, hip, back surgery | No | 722.800 |
| Viactiv Krankenkasse | not specified | not specified | 693.900 |
| Handelskrankenkasse | Back surgery | No | 678.200 |
| Pronova BKK | Back, Hand, Hip, Knee, Foot Surgery | No | 660.300 |
