Health insurance companies have to cover the corona vaccination from April. So far, the federal government has paid. But there is a dispute about the amount of the fees. The doctors want about three times as much money as for a flu shot.
In November 2021, the then Federal Minister of Health Jens Spahn was once again generous to the resident doctors. Until then, they received 20 euros for a corona vaccination, in addition to the usual quarterly flat rate for each patient. But in order to boost the booster campaign against Corona, Spahn increased the vaccination fee to 28 euros, and even to 36 euros at the weekend. That doesn’t even include the cost of the vaccine.
For some medical practices, the corona vaccinations were extremely profitable. Practices got partly Tens of thousands of euros a week. The federal government paid a total of around 2.7 billion euros to resident doctors for corona vaccinations.
Compensation not yet negotiated
However, the current regulation expires on April 7th. After that, the health insurance companies have to cover the costs for the vaccinations. However, it is unclear to what extent. The Associations of Statutory Health Insurance Physicians (KV), which represent the interests of doctors, and the state associations of health insurance companies are currently negotiating nationwide.
Most of those involved remain silent about the status of the talks. The KV Bremen, for example, reports that “for reasons of negotiation tactics, no information can be given.” The KV Bayern admits: “Currently, the ideas about appropriate remuneration are still very far apart”.
And the KV Westfalen-Lippe said on request that they did not expect an agreement through negotiation. Because the remuneration ideas would be very far apart, according to the local KV. She was one of the few who gave specific numbers. The KV Westfalen-Lippe wants the doctors to get as much as before for the corona vaccination. The doctors’ representatives in Lower Saxony and Saxony also confirmed that they are asking for 28 euros.
Funds consider claims to be excessive
It has been heard from health insurance companies that they consider this amount to be grossly exaggerated. Most of the corona vaccinations that are still administered today are booster vaccinations. Those affected would know about the vaccination, would no longer need to be informed as comprehensively as the first time and would also have fewer questions.
The AOK Federal Association considers “orientation towards the existing fees for individual vaccinations to be necessary”. This also corresponds to the legal requirements. For individual vaccinations such as the flu vaccination, doctors receive between 7.60 euros in Rhineland-Palatinate and 9.18 euros in Thuringia, also in addition to the quarterly flat rate.
Disputes could be expensive
According to information from NDR, WDR and “Süddeutsche Zeitung” (SZ) there is no agreement in sight in any federal state. If the fronts remain rigid, the corona vaccination for health insurance companies could end up being even more expensive than before – at least temporarily. “In this case, the doctors would then provide the services according to the GOÄ (Fee schedule for doctors, the editors) provide and bill, “said the spokesman for the KV Westfalen-Lippe, Daniel Müller. The Association of Statutory Health Insurance Physicians of Lower Saxony sees it that way. However, that does not mean a fee of between eight euros and 28 euros, but significantly more.
“According to the GOÄ, average costs of around 60 euros are charged for vaccinations,” says Detlef Haffke, spokesman for KV Lower Saxony. The insured would then first have to pay for these costs, but they can be reimbursed by their insurance company. “This (very unlikely) case would cause considerable administrative work for the health insurance companies,” said a spokesman for the AOK federal association.
How long this situation could last is unclear. If insurance companies and medical representatives do not agree, the fee amount will be determined in an arbitration procedure.