Private Doctor Reimbursement in Austria: What ÖGK Really Pays

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Private Doctor Costs: What Does ÖGK Reimburse?

More and more Austrians visit private doctors. But many are surprised at how little the statutory health insurance (ÖGK) actually reimburses. In this guide, you'll learn how cost reimbursement works and what gaps remain.

The 80% Rule: A Misunderstanding

What Many Believe vs. What Actually Applies

Common misconception: "ÖGK reimburses 80% of the private doctor bill."

Reality: ÖGK reimburses 80% of the public tariff – not 80% of the actual private doctor bill!

What Does This Mean Concretely?

Item	Amount
Private doctor fee	€150.00
Public tariff for same service	€50.00
ÖGK reimbursement (80% of public tariff)	€40.00
Your out-of-pocket	€110.00 (73%)

Important: Since private doctors can set their fees freely, you often only get 20-40% of the actual costs reimbursed!

Cost Examples for Common Doctor Visits

Private Doctor Costs vs. Reimbursement Comparison

Doctor Visit	Private Doctor Cost	Public Tariff	ÖGK Pays	You Pay
General Practitioner	€100	€45	€36	€64
Gynecologist	€150	€50	€40	€110
Dermatologist	€120	€40	€32	€88
Orthopedist	€180	€55	€44	€136
MRI (Private Institute)	€350	€180	€144	€206
Pediatrician	€120	€40	€32	€88

How to Submit Your Claim

Step-by-Step Guide

1. Receive Invoice from Private Doctor

• Must list all services in detail
• Diagnosis and date must be included

2. Pay the Invoice

• Most private doctors require cash payment or bank transfer
• Keep proof of payment

3. Submit to ÖGK

• Online via WAHonline (available since July 2024)
• By mail to your ÖGK regional office
• In person at ÖGK customer service

4. Receive Reimbursement

• Processing time: approx. 2-4 weeks
• Transfer to your account

Required Documents

• Original invoice (for postal submission) or scan (for online submission)
• Proof of payment
• e-card number or social security number

Tip: Since July 2024, you can submit private doctor invoices digitally via the ÖGK WAHonline portal. This is faster than by mail.

Closing the Private Doctor Gap: Supplementary Insurance

How Private Doctor Insurance Helps

Private doctor insurance (outpatient supplementary insurance) covers the difference:

Item	Without Supplement	With 80% Tariff	With 100% Tariff
Private doctor bill	€150	€150	€150
ÖGK reimbursement	€40	€40	€40
Supplementary insurance pays	-	€88	€110
Your out-of-pocket	€110	€22	€0

What Does Private Doctor Insurance Cost?

Typical monthly premiums (depending on age and tariff):

• 80% tariff: approx. €25-75/month
• 100% tariff: approx. €40-120/month

Why Do Austrians Visit Private Doctors?

Main Reasons

1. Shorter Waiting Times

• Public doctor: Often weeks or months waiting time
• Private doctor: Usually short-notice appointments possible

2. More Time Per Patient

• Public doctors: Average 5-10 minutes per patient
• Private doctors: Often 30-60 minutes per appointment

3. Free Choice of Doctor

• For some specialties, there are few or no public doctors
• Specialized treatments often only available at private doctors

4. More Modern Equipment

• Private practices often invest more in equipment
• Latest diagnostic and treatment methods

Frequently Asked Questions About Private Doctor Reimbursement

How Long Do I Have to Submit?

The deadline is usually 42 months (3.5 years) from the invoice date.

Which Services Are Not Reimbursed?

• Purely cosmetic treatments
• Non-medically necessary services
• Treatments by non-licensed practitioners

Can I Submit the Invoice Without Payment?

No, ÖGK only reimburses invoices already paid. You must provide proof of payment.

What If the Public Tariff Is Higher Than the Private Doctor Bill?

In that rare case, you receive 80% of the public tariff, so more than the actual costs.

Conclusion: Private Doctor Costs in Austria

ÖGK reimbursement for private doctor visits usually covers only 20-40% of actual costs. Those who regularly visit private doctors should consider private doctor supplementary insurance.

Summary:

• ÖGK reimburses 80% of public tariff, not the private doctor bill
• Out-of-pocket often 60-80% of costs
• Online submission via WAHonline possible
• Supplementary insurance closes the gap

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Disclaimer: The amounts and examples mentioned are for orientation. Actual reimbursements depend on specific public tariffs and services. For binding information, contact your ÖGK regional office. CheckEverything.at assumes no liability for the accuracy of the information.