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John Riceburg: The road to wellness

Germany's supposed to be the land of psychotherapy, no? Therapy is even covered by health insurance. But how easy is it to get in the end? John Riceburg recently went down that road (and made it!), but encountered a lot of pitfalls on the way.

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Photo by miss_millions (CC BY 2.0, Flickr)

I got into psychotherapy!

Normally healthcare isn’t so exciting. But there’s a reason my opening needed an exclamatory. And here it is: the road there was really stressful. All told, it took about 15 months between my first Google search and my first therapy session and even afterwards, trouble arose.

On paper, getting psychotherapy in Germany seems easier – certainly compared to the United States. At least it’s covered by insurance. But therapy still isn’t cheap – about €100 a session – so insurers will put all kinds of bureaucratic hurdles in the way.

I’m insured with the TK, a gesetzliche Krankenkasse, one of Germany’s state-subsidized, tightly-regulated insurers. Germany has over 100 Krankenkassen, each with their own rules and bureaucracies to enforce these. Plus there are private insurers which are horses of a different colour. So experiences can vary.

The first step was finding the damn therapist – by far, the worst part. Most I found didn’t even use e-mail. I needed to find telephone numbers in an online directory (tip: if you put “Englisch” into the “Stichwortsuche”, you can find English-speaking therapists) and then speak to their answering machines. Most didn’t even answer. Many more said they’re not taking new patients. I must have made at least 30 calls – a wave of rejection right at the beginning was the last thing I needed when dealing with depression.

Once I found someone at least offering an appointment, my search wasn’t over. I went on trial. A trial session. I had several, and after trying a few out, it made me feel desperate. I encountered at least two therapists who seemed like real sadists, happy to offer far-fetched diagnoses in less than 10 minutes. It hurt hearing stuff like that from a professional. So while having to go to the trials seemed to prolong getting the therapy, I’m glad I did it. There’s no sense in opening up to a therapist at a trial session if the feeling’s not good.

After finally finding a doctor, new headaches arose… now I had to deal with my insurance company. Which is trickier than one first thinks.

If a therapist here has a permit from the local medical association (known as a Zulassung der Kassenärztlichen Vereinigung) this is usually not so tough. They can just use your insurance card, an Überweißung from your general practitioner, and all the paperwork is done behind the scenes. (You should find a therapist before you go to your GP. A therapist can usually do a few sessions with you before you get an Überweisung. Finding a therapist takes forever, and getting the Überweisung is super quick).

But many therapists don’t have one of these permits. This doesn’t mean they’re unqualified – it’s just that the permits are strictly limited. Young and foreign therapists often fall into this category. If that’s the case, one has to pay out of pocket… and then go through the dreaded reimbursement procedure. Insurance companies spend months considering the application and then might still deny it for arbitrary reasons – for example they might claim to know a therapist with the permit who could offer the same service, even if it turns out that he or she is not taking new patients.

My own situation was even more complicated because I’ve been in therapy on and off for about six years. Three years ago I was able to get reimbursed for an English-speaking therapist after a wait of several months. But since then, I started doing therapy in German because it was so hard to find English speakers who were acceptable to the TK.

After that course of therapy was completed, I went looking for another one. But the TK bureaucracy had entered into their database that I had been “healed”. That seems kind of arbitrary, right? But that made even more angry phone calls to them necessary in order to get more treatment.

Like dealing with any bureaucracy, the trick was to be persistent. I called them non-stop, wrote letters and learned some of their vocabulary and used it against them. I know that at the end of the day they had to give it to me. They were just trying to save some money by delaying as long as possible.

But after months and months of bullshit, now I’m doing group therapy and it’s paid for. I won this little battle against an infamously bureaucratic system. Ultimately, there’s little more trick to it than patience and persistence. If I had known what I was in for from the beginning, the I could have saved myself a headache. So if you’re thinking of seeking help yourself, know that it might not be easy, but you can still get it.

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