Is it possible to find a therapist covered by your health insurance? What if you have private insurance? Any chance of finding an English-speaking therapist in Hamburg who can see you in person?
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Finding a therapist in Hamburg (and in every big city in Germany) can be really challenging. From understanding health insurance intricacies to finding a therapist who speaks your language and suits your needs, the process can make you feel overwhelmed. Here, we will try to explain how the system works and give you practical tips for navigating the path to finding the right therapist in Hamburg.
Picture: Tom Fisk, Pexels
How to get your Psychotherapy Sessions covered by Health Insurance
The German healthcare system can sound appealing when you come from a different country and you discover that here the cost of your psychotherapy sessions can be covered by your health insurance. It seems too good to be true! In fact, reality can be slightly more complex (as usual). Let’s try to dig into this.
First of all, you need to know that there are two different types of health insurance:
Public health insurance (like, for example, TK or AOK)
Private health insurance.
Public Health Insurance and Psychotherapy
If you have public health insurance, you can benefit from having a certain number of sessions completely covered. To know which therapists are in the network, the easiest is to look at the list provided by your health insurance company. For example, if you have TK, you should find a psychotherapist in their directory here (you can also choose the language): https://www.tk-aerztefuehrer.de/TK/englische-suche.htm
So far, so good. Now, you probably will start to contact one or two people from the list, and what you realize is that you don’t get the answers you were hoping for. Most of them are fully booked, and some others have waiting lists of at least 3 to 6 months. Even contacting the entire list, it’s possible that the result won’t change. If you happen to be lucky enough and you receive an answer from an accredited psychotherapist in your health insurance, you will schedule a trial session, where the therapist will confirm that you need treatment. Then, you are entitled to 2 to 4 trial sessions, with the aim to get an initial diagnosis. Only after these sessions, the therapist will make a case for why there is a medical need for the patient to have sessions covered by health insurance. Based on this case, your insurance will decide whether they approve your therapy. The most common reasons to get your psychotherapy sessions approved are Anxiety Disorder, Depression, Eating Disorder, Personality Disorder, Psychosomatic Disorder, Addiction, Behavioral Disorder, Obsessive Compulsive Disorder.
In summary, two criteria need to be met to have your sessions approved by public insurance:
The psychotherapy practice must be approved by the health insurance
Medical Need/Diagnosis of Mental Disorder
Unfortunately, after approval, the therapist in the network is not obligated to take you on again if they do not have space or for any other reason. So, you’ll have to wait again - sometimes for more than a year - to get your real therapy sessions started.
Finding a therapist under public health insurance can be incredibly challenging. For some, it might seem nearly impossible. Even native Germans struggle with this process. At some point, you might have to choose to get a specialized private insurance add-on, fight for reimbursement, or pay out of pocket.
Useful links for your search:
Kassenärztlichen Vereinigung Hamburg: http://www.ptk-hamburg.de Search: http://www.psych-info.de
Private Health Insurance Plans, Add-on Plans, and Psychotherapy
If you have private health insurance you need to check with your insurance what services are covered. There don’t seem to be any specific criteria or rules because insurance providers can decide what to cover in their plans.
Once you have ensured that you can get psychotherapy covered by your private health insurance, the process is similar to the one with public insurance, but you have more flexibility in choosing your therapist. For example, you can choose from both “Psychologische Psychotherapeuten” and therapists who hold the title of “Heilpraktiker für Psychotherapie”. We will write our next blog post on the difference between different titles in Germany (with special attention to expat therapists), but basically, both titles allow the practice of psychotherapy under German law. This can give you more options and it can become easier to find a therapist who speaks your language.
The website Therapie.de allows you to filter therapists based on location, specialty, language proficiency, and accepted insurance (public, private, or out-of-pocket).
There is also a possibility to opt for a supplemental insurance plan specific to Psychotherapy. This can usually be done on top of your public or private health insurance. Here you can find additional information regarding conditions for coverage and included services:
Reimbursement Request
Your public insurance company may be willing to cover the cost of psychotherapy even with a therapist who isn’t in the network ("Kostenerstattung"). Listening to our clients’ experiences requires a lot (a lot!) of patience, and determination and you should be aware that the company always has the final word and can decide that you are not eligible even when you have all the documentation needed. Briefly, you have to keep a log of when you contacted therapists who weren’t available (5 calls should work) being specific about people you contacted and when. If you can have a prescription from your GP that you need psychotherapy, that should also help. Then you put all your information in a letter (in German, of course) and you send it to your health insurance company. They can then decide if you are allowed to have psychotherapy covered by them even with an out-of-network therapist.
Pros and cons of Health Insurance covering the cost of psychotherapy:
Pros:
Cost: With a certain number of sessions covered by the health insurance, you can save some money
Licensed psychologists: To be approved within the Public Health Insurance’s networks, therapists have to be “Psychologische Psychotherapeuten", which means they have a state-approved Master's degree plus a minimum 3-year postgraduate program in psychotherapy (again, we will talk more about titles in our next post - this is already a lot of information for now!)
Cons:
Overwhelming bureaucracy: The process can get exhausting and you can be discouraged along the way. Not receiving any answer when you feel like you need help, after all the effort you put in asking for help in the first place, can result in hopelessness and demoralization.
The right fit: When you find a therapist who has availability, you will probably stick to that one since it is so difficult to find someone else. This means that even if the therapist is not the perfect fit for you, you will stay just because you don’t want to go through the whole process again.
Limited therapy approaches and modalities: You can choose only from the approaches approved by the public health care system, these are: Psychodynamic Psychotherapy, Cognitive-Behavioral Psychotherapy, Psychoanalysis, and - recently added - Systemic Psychotherapy. Other approaches, for example, Solution Focused Therapy, or Somatic Therapy, are only covered by some private health insurance plans. If you don’t have that, you must pay out of pocket. The same happens if you choose to do some other modality than Individual Psychotherapy, for instance Couples Therapy.
Limited flexibility between online and in-person: many insurance companies do not reimburse for online sessions. Licensed psychotherapists are limited to a certain percentage of online sessions and the first session always needs to be in person - diagnosis cannot be given online.
Language barrier: While many therapists may offer services in German, the availability of professionals speaking different languages may be limited in the health insurance system.
Psychotherapy and Private Pay
If you would like to have a wider set of options and have the financial means, then private therapists are definitely your best choice. Not only do they offer flexibility by combining in-person and online sessions, but many also reserve space for sliding scale fee clients, particularly for students or those with low incomes, ensuring affordability without compromising quality. Opting for an out-of-network therapist grants you the advantage of selecting someone who truly aligns with your needs and preferences.
You may think now: how do I find a therapist if I don’t have any referral and any clue about where to start my search?
One of the most popular therapy directories in Germany, It’s Complicated, boasts over 1500 therapists worldwide, making it an interesting starting point for your search. With diverse criteria such as city and language, you can tailor your search to your specific needs. The professionals listed on It’s Complicated typically include Psychologists, Psychotherapists, and Counselors, and it is not excluded that you can also find therapists listed there, who are affiliated with a public or private health insurance company.
If you live in Hamburg, and you are looking for therapy (in person or online), we can help you! We decided to create Expat Couch after noticing how difficult finding a therapist in Germany can be. We are expat therapists and we offer English sessions (we also speak German and Italian). Our mission is to create a supportive environment where individuals can meet in person, fostering a sense of community among expats.
Picture: Alex Green, Pexels
Conclusion
Finding the right therapist in Hamburg, Germany, is undoubtedly a journey filled with challenges and uncertainties. From navigating the complex health insurance system to overcoming language barriers and determining the best mode of therapy, the process requires patience, perseverance, and resourcefulness.
By leveraging available resources, seeking recommendations, and advocating for your needs, you can increase the likelihood of finding a therapist who aligns with your requirements. Whether you choose to pursue therapy online or prefer the intimacy of in-person sessions, prioritizing your mental health is a vital step toward your well-being.
In case of an emergency
If you are based in Hamburg, Germany, and need urgent help, these are the contacts for you:
https://www.hamburg.com/welcome/health-insurance/15496674/psychologicalstress/ (Hamburg)
Telefonseelsorge www.telefonseelsorge.de (Germany)
Kinder- und Jugendtelefon Nummer gegen Kummer (Mo-Fr 15:00-19:00) www.nummergegenkummer.de (Germany)