Right to remuneration

The provision of § 12 para. 1 GOÄ stipulates, as a legal peculiarity for the medical fee, that the private medical fee is only due when the payer has received an invoice corresponding to the GOÄ. Thus, the physician is generally obliged to provide his services to the patient in advance. However, neither the GOÄ nor the professional codes of conduct explicitly prohibit advance payments.

Advance payment: There is a wide range of opinions in legal literature on the question of whether a doctor may take advance payment, which either affirm or deny advance payment. A conciliatory view is based on the existence of special conditions, such as advance payment for material costs, or there are justified doubts on the part of the physician as to the patient's ability or willingness to pay. There is only agreement that medically necessary and urgent treatment may not be made dependent on an advance payment. This would amount to an exploitation of the patient's predicament. For the rest, however, the legal situation is unclear and the case law is inconsistent. There have already been professional court proceedings in which a doctor has been accused of demanding advance payments with corresponding penalties. A legally enforceable claim for advance payments does not exist. An action for compensation against the patient before the invoice is issued would not be successful.

Rejection of a patient: Apart from medical emergencies, the physician in private patients may, unlike the contract physician in SHI patients, generally reject treatment. This can, for example, be made dependent on whether the previous invoice was paid. If the invoice is issued immediately after the first treatment appointment, clear conditions can be established relatively quickly.

If the doctor wants to play it safe in terms of professional law, he should not demand an advance or at least not expose himself to the demonstrable accusation of a systematic approach of this kind. However, if a patient makes an advance payment on his or her own initiative without the doctor having demonstrably requested it, there should be nothing to prevent this from happening legally.

1. Hellweg, (R 2014) Remuneration Law, Dermatology Business Letter 10: 3