Waiting months for a therapy place is not a personal misfortune you have to absorb. Statutory insurance owes you psychotherapy as a benefit, within a reasonable time. Where the system cannot deliver it, the law has an answer — the insurer pays for a private therapist instead. Very few people claim it, because very few people know it is there.
1. The route the system expects you to take
Psychotherapy under statutory insurance runs through a fixed sequence, and skipping it is the most common reason a later reimbursement claim fails.
- The psychotherapeutic consultation (Psychotherapeutische Sprechstunde) comes first — a short appointment with a licensed therapist that establishes whether treatment is indicated, how urgent it is, and what kind.
- You leave with a written outcome. This document is the foundation of everything that follows: it records a professional's judgement that you need therapy and how quickly. Keep it.
- Acute treatment exists for urgent situations and does not need prior approval from the insurer in the way a full course does.
- The appointment service reachable on 116117 is obliged to help arrange appointments within defined periods. Use it, and record what it offers you — including when it offers nothing usable.
Only after this does the real problem appear: a recommendation for therapy, and no therapist with a statutory-practice licence who has a free place this year.
2. When the system fails, it has to pay
German social law contains a provision for exactly this situation. Where an insurer cannot supply a benefit it owes you in the required time, and you then obtain that benefit yourself, it must reimburse the cost you necessarily incurred. This is the reimbursement route — Kostenerstattung — under § 13 Abs. 3 SGB V, and psychotherapy is where it matters most, because the shortage of places is structural rather than occasional.
The argument is not that you would prefer a private therapist. It is that the insurance system was unable to provide what it is legally required to provide, so you had to go outside it. That distinction is the whole case, and it is why the evidence below matters more than the wording of your request.
3. The search you have to be able to prove
An insurer will not take a shortage on trust. What decides these cases is a documented, unsuccessful search for a place within the statutory system. Keep a simple log, and keep it as you go — reconstructing it afterwards is far weaker.
For every therapist you contact, record:
- the name and practice;
- the date you made contact;
- how you contacted them, and what they said — no places, a waiting list, a waiting time in months, no call back at all;
- any waiting time you were quoted.
There is no single statutory number of rejections that settles it, and practice varies between insurers and courts — but a handful of contacts is generally treated as too few, and a longer, dated, specific list is far harder to dismiss. Emails and call logs are better than memory. Add what the appointment service offered you, and keep the written outcome from your consultation with it.
4. The order of steps decides the outcome
This is where most claims are lost, and it is entirely avoidable.
Apply to your insurer before you start private treatment, and wait for the decision. The reimbursement route is built around the insurer having had the chance to refuse first. Treatment you arrange and begin before there is a decision is generally treated as your own choice rather than a failure of the system — however genuine the shortage was.
So the sequence is: consultation and written outcome, documented search, written application to the insurer setting out both, decision, and only then treatment. Check as well that the private therapist holds the appropriate professional licence (approbiert), since reimbursement of an unlicensed practitioner is a different and much weaker argument.
And note the clock running on the other side: insurers must decide applications within fixed periods, and one that neither decides nor explains its delay in writing may be treated as having approved. Our guide to a refused Krankenkasse decision covers that rule.
5. Therapy in English
If you need therapy in a language you actually think in, the shortage stops being structural and becomes close to absolute. Therapists holding a statutory-practice licence and working in English are rare in most of Germany and effectively absent outside the large cities.
Whether language on its own obliges an insurer to fund a private therapist is arguable rather than settled — it is not a guaranteed win, and you should expect it to be contested. The argument that carries weight is a clinical one rather than a preference: that therapy conducted in a language you have limited command of cannot achieve what it is meant to achieve, which is a point your consultation outcome or a treating doctor can support in writing far better than you can.
Practically: run the same documented search, but record language explicitly each time — that a practice had no place, or had a place but no English. A list showing both is a much stronger document than one showing only the first.
6. If they refuse anyway
A refusal is a formal decision, and it starts a one-month window to object. Objecting is free, needs no lawyer, and needs no completed argument — your details, the reference number, the date of the decision and a sentence saying you object are enough, with grounds to follow.
If the objection is rejected, the further step is the Sozialgericht, which for insured people carries no court fees. This corner of German law is deliberately built to be usable without money.
Meanwhile, do not stop treatment you are already receiving, and do not let the search log go cold — a refusal followed by three more months of documented rejections is a stronger position than the one you started from.
The short version
Get the consultation and keep its written outcome. Then search, and write down every contact, date and answer as you go. Apply to the insurer, in writing, before you begin private treatment — that order is what most claims fail on. Object within the month if they say no, because it is free and it is the only step that cannot be taken later.