How to apply for Kostenerstattung for psychotherapy, step by step

Who can use Kostenerstattung

You need to be publicly insured (GKV), a therapist has to have confirmed that you need treatment, and the wait for a Kassensitz therapist has to be unreasonable. The Bundespsychotherapeutenkammer (BPtK) treats waits of more than three months as generally unreasonable. The therapist you want to see must hold an Approbation, the state licence to practise psychotherapy, and offer a type of therapy that GKV covers. They don't need a Kassensitz, which is the whole point.

With private insurance this route doesn't apply, because your contract decides what is covered. If you pay for therapy yourself, no insurer is involved.

Step 1: Get a Sprechstunde and your PTV 11

Start with a psychotherapeutische Sprechstunde, a short assessment with a Kassensitz therapist. If you can't find one yourself, the Terminservicestelle (116117) has to arrange one within four weeks. At the end you get the PTV 11 form, which records whether treatment is recommended and how urgently. It is what shows your Krankenkasse that the treatment is needed, so keep the original and make a copy.

Step 2: Contact Kassensitz therapists and log every answer

Next, ask therapists with a Kassensitz for a treatment place, and write each attempt down as you make it. This log is the core of your application. For each practice, note:

• The practice name and how you contacted it: phone, email or contact form.
• The date and time of your request.
• What they answered: no capacity, a waitlist, or no reply at all.
• The earliest start date they offered, if they offered one.

The law doesn't set a number of attempts, and Krankenkassen differ in what they expect. Ask yours what it wants before you start, in writing if you can. Emails are easier to prove than phone calls, so where a practice offers both, write.

Download a blank contact log (Excel)Its columns are the ones a Krankenkasse looks for, labelled in German with English in brackets, and it opens in Excel, Numbers and Google Sheets. You fill it in on your own device, and it never reaches us.

Step 3: Ask 116117 for a treatment place too

Many Krankenkassen want to know whether you also asked the Terminservicestelle for a treatment place, not just for the Sprechstunde. Ask, and add the result to your log with the date. If 116117 gives you nothing in writing, note when you called and what you were told.

Step 4: Find a licensed private therapist with a place

Look for a therapist in private practice (Privatpraxis) who can start soon and is willing to treat you through Kostenerstattung. The therapist search of the Deutsche Psychotherapeutenvereinigung at dptv.de can filter for exactly these practices. Ask them for a short written confirmation of when you could start and which therapy they would offer. Some Krankenkassen also want a certificate of urgency from your GP (Dringlichkeitsbescheinigung). Asking for it early saves you a second round.

Step 5: Send one complete application before therapy starts

Write to your Krankenkasse and ask it to cover treatment with the named private therapist under § 13 Abs. 3 SGB V. Send it before your first therapy session: costs from before the decision may not be reimbursed, and the BPtK strongly advises applying first. Attach:

• Your PTV 11.
• Your contact log, including the 116117 result.
• The private therapist's confirmation of a start date, with their name and Approbation.
• A certificate of urgency from your GP, if you have one.

Send it by post with proof of delivery or through your Krankenkasse's online member portal, and keep a copy of everything you sent. Your Krankenkasse works in German, so write in German if you can.

Step 6: Wait for the written decision, and know the deadline

Under § 13 Abs. 3a SGB V your Krankenkasse has to decide within three weeks of receiving the application. If it asks the Medizinischer Dienst for an opinion, it has five weeks and has to tell you that it asked. If it can't meet the deadline, it must tell you in writing and give a reason.

If the deadline passes with no decision and no reason, the law treats the application as approved, and the Krankenkasse has to reimburse a necessary treatment you arrange after that. Since a 2020 ruling of the Bundessozialgericht, this gives you a right to reimbursement rather than a full approval, so get advice before you rely on it.

Once you're approved, ask both the Krankenkasse and the therapist how billing will work. Sometimes the practice bills the Krankenkasse, sometimes you pay and claim the money back. Settle it before the first session.

If your Krankenkasse says no

A rejection is a formal decision (Bescheid), and you can object to it with a Widerspruch within one month of receiving it (§ 84 SGG). The objection is free. Say that you object, name the decision by its date, and answer the reason the Krankenkasse gave. If it said you didn't contact enough practices, add the attempts you've made since. If it pointed you to 116117, add that result. Rejections are common enough that it's worth expecting one and keeping your log going in the meantime.

Doing it yourself, or with help

Nothing above needs a lawyer or a paid service, and you can do all of it yourself. What makes it hard is the effort of chasing practices and writing a formal application in German. TheraPlatz's reimbursement add-on prepares the application and documents and follows up with your Krankenkasse, and we check whether you qualify before doing any of that. The steps are the same either way.