Johannes W., a government employee, had had an inexplicable headache for several days. The anxious young man from Berlin wanted to go straight to a specialist and have a computer tomography (CT) of his head done. A family doctor in Berlin-Kreuzberg was recommended to him by friends because this family doctor was generous with referrals “with urgency”. This code on the transfer slip enables you to book timely available appointments for urgent cases via the appointment service point.
Johannes W. went to the family doctor, received the referral with the urgency code and booked a free appointment with a neurologist on the outskirts of the city the day after next via the appointment service point, also known as number 116117. In the end, the CT scan turned out to be unremarkable. The specialist was able to bill the young man’s visit as a so-called extra-budgetary service, i.e. as a fee beyond the practice’s fixed fee pool, and also received a surcharge for the “urgent” treatment.
Perceived “urgency” is increasing
The number of specialist appointments due to real or perceived “urgency”, which can be charged higher by specialists, has increased. The problem: In many places they are becoming the norm as a way to even get an appointment with a specialist.
To do this, family doctors either issue urgent referrals that you can use to contact the Book a quick appointment at the appointment service point or they arrange an appointment with a specialist directly through their own family doctor’s practice, as a so-called “family doctor placement case”, which according to the law must also be “urgent”. In the latter case, the family doctors also receive a flat rate of 15 euros for the placement. In both cases, the specialists can charge extra budget and with surcharges of up to 100 percent.
The problem: The waiting times for specialist appointments have not been shortened. Only the costs have increased
In the first quarter of 2025, specialists billed around 1,175,000 so-called family doctor placement cases; two years earlier there were only 710,000 cases, according to figures from the Techniker Krankenkasse. 387,000 cases were billed as so-called appointment service cases; the numbers have doubled within two years.
Federal Audit Office: Waiting times remain the same
The supported placement takes place on the basis of the so-called Appointment Service and Supply Act, that came into force in 2019 and was updated in 2023. The problem: The waiting times for specialist appointments have not been shortened as a result, as one already showed Evaluation of the Federal Audit Office. Only the costs have increased.
“The statutory health insurance companies pay more than 500 million euros every year for appointments, even though the insured are not treated faster or better as a result,” explains Jens Baas, CEO of the Techniker Krankenkasse (TK), when asked by the taz. “Previous legal regulations to get people to specialist medical care more quickly do not work, but they cost the statutory health insurance companies a lot of money,” complains the deputy CEO Stefanie Stoff-Ahnis from the GKV umbrella association of health insurance companies.
In the second quarter of 2025, the health insurance companies incurred additional costs of 137 euros for each family doctor placement. According to the GKV figures, additional costs of 112 euros were incurred for each arrangement via the appointment service point.
Boom with the “urgency”
Billing via the urgency code or the GP referral case is “developing into the new normal,” warns Doris Höpner, co-chair of the Berlin-Brandenburg GP Association, at the request of the taz. “General practitioners are noticing that patients increasingly want an urgency code on the referral,” said the co-chair. She is also becoming increasingly aware of cases in which specialists “require an urgency code from the patient”.
In Berlin, a patient says that a pulmonary specialist’s practice turned her away when she wanted an appointment for a routine examination with a normal referral from her family doctor. She was told that she should please go back to the family doctor and get an “urgent” referral. Otherwise there will be no appointment. Included was a reference to a particular family doctor’s practice in Berlin that was particularly generous with “urgent” referrals.
A case is also reported in Hesse where a neurologist only wanted to accept a referral “with urgency” in order to even give an older gentleman an appointment. The senior needed an initial examination.
The “urgent” business is booming, even if patients simply need an appointment for an unspectacular examination with a specialist. This thwarts the efforts of health insurance companies to encourage patients to take more personal responsibility and not to dramatize their complaints.
Some are “excited about the new form of billing”
But specialists don’t have a bad conscience about this. Because they complain that due to the budgeting of fees for the practices, many services are now having to be provided virtually for free. A regulation that allows remuneration outside of these budgets and with bonuses of up to 100 percent is just right.
Ear, nose and throat doctor Uso Walter wrote on the platform “Hnonet” excited about the new form of billing. “In my practice, since last year, we have consistently accepted new patients only with a family doctor referral. Patients who are already known have the choice: either waiting for hours in the open consultation hours, an appointment in three to five months or an immediate appointment with a moderate waiting time due to a family doctor referral. A win-win situation for all family doctors, patients and ENT doctors.”
Statutory insured patients have to laboriously find their way through this jungle of special referrals, appointment service points with the number 116117 and the “acute consultation hours” that are often not even displayed on the Internet. Just a few days ago The Doctolib platform was convicted of misleading people with statutory health insurance – the Federal Association of Consumer Organizations (vzbv) had sued.
At Doctolib, those with statutory health insurance, especially if they are new patients, may still have appointments several months in advance or in a remote practice on the outskirts of the city. You can also come to the “acute consultation hours”, which many specialists have to offer but often do not display on the internet and only provide on request, without an appointment. But the requirements are strict. Woe betide you, the lumbago has been bothering you for weeks, then the orthopedic surgeon doesn’t recognize this as an “acute case” and treats the intruder from the practice without an appointment who got in line at eight o’clock in the morning with a grumpy attitude at best.
In everyday life, however, you might just want to finally talk to an expert about your chronic skin problems or get a second opinion from a specialist, even if it’s not urgent. And then the hurdles to the specialist appointment begin.