The Frankenthal (Palatinate) Regional Court (Az. 2 S 75/25) made it clear in the appeal process that a doctor only has to explain possible cost risks of an operation if there is evidence that the health insurance company will not fully cover reimbursement. Special personal responsibility obligations apply to privately insured people.
Dispute over cost clarification and payment obligation
The starting point of the legal dispute was a medical bill for just over 2,000 euros for an operation on the nasal mucosa. The patient sought medical help because of problems with nasal breathing and was recommended surgical treatment. There was no information about the expected costs.
After the operation was carried out, the patient refused to pay: the measure was medically unnecessary and he was not informed that he was responsible for clarifying who would cover the costs. He further claimed that the practice staff had assured him that his private health insurance would cover all expenses.
After taking evidence, the Ludwigshafen district court decided that the patient had to pay the bill in full – regardless of the extent to which his private insurance paid. He appealed against this verdict. The 2nd Civil Chamber of the Regional Court now again dealt with the question of whether the doctor had violated his financial information obligations and whether there was still a claim to payment.
LG confirms obligation to pay despite no reimbursement of costs
The regional court confirmed the first instance judgment.
There is a legal obligation to provide economic information to protect patients from unexpected financial consequences. However, this obligation only applies if the doctor can recognize that the costs may not be reimbursed. In the case of privately insured patients, it can generally be assumed that they themselves are informed about their insurance coverage, because only they know the contractual conditions and the usual reimbursement practices of their insurer.
A doctor has medical expertise, but is not obliged to check the complex regulations of private health insurance companies. In addition, the patient was unable to prove that the practice’s employees had guaranteed full coverage of the costs. The medical necessity of the procedure was proven by an expert opinion, so that the treatment was technically justified.
After withdrawing the appeal, the district court’s decision is now legally binding.
Tipp: Before medical interventions, you should always check with private health insurance whether and to what extent services will be reimbursed. It is also advisable to provide written clarification about any statements made by practice staff in order to avoid later problems with evidence.
