At the patient's request

Right to automatic elective doctor billing from July

From July, doctors will be legally obliged to submit a claim for reimbursement online for patients who request it.

(Bild: APA/ROLAND SCHLAGER)

Due to the long waiting times for appointments with statutory health insurance physicians, patients are increasingly forced to see a doctor of their choice. They first have to pay the costs themselves and then submit the invoice to their health insurance provider in order to be reimbursed for at least part of the costs. From July 1, this process will be simplified. 

Doctors will then be legally obliged to submit the invoice for reimbursement online for patients if they so wish.

More service, faster processing
The Austrian Health Insurance Fund (ÖGK) sees this as a "good story in the direction of more service quality", says Director General Bernhard Wurzer. For patients, electronic submission will speed up the processing of claims, which will then be reimbursed at 80 percent of the respective health insurance tariff. The aim is to reduce this to two weeks. Currently, it takes three to four, in some cases significantly longer.

Optional dentists are not part of the regulation. Another restriction: there will be a de minimis limit on annual turnover, below which doctors who only work sporadically will not have to deal with the billing system and will not have to worry about integrating it into their practice software.

Expenditure for elective medical services

ÖGK's expenditure on elective medical services amounted to 184 million euros in 2022, which is 6.6 percent of the expenditure for doctors in private practice. In total, the health insurance fund spent 2.8 billion euros on services provided by contract and elective doctors.

How high the limit will be has not yet been defined, however, but is still the subject of negotiations with the Medical Association. If it were set at 15,000 euros, analogous to the cash register obligation, a good 90 percent of all cases would be covered.

ELGA also for elective doctors
The new system does not require elective doctors to use the e-card. However, improvements will be made here too - as decided last year: from January 1, 2025, they will be connected to the e-card and the use of the electronic health record (ELGA) will also be mandatory for elective doctors from then on.