Non-accredited doctors are resident doctors not under contract with the WGKK. They are thus not bound to the agreed fees and services. If non-accredited doctors are consulted, this is done as a private patient and the doctor’s fee has to be paid by the patient.
WGKK customers are entitled to some cost reimbursement after visiting a non-accredited doctor – if the entitlement conditions are met.
Subject to law, the WGKK is only allowed to reimburse 80 percent of that amount the Health Fund would have had to pay for the equivalent service rendered by a contractual partner, but no more than the fee actually paid at the non-accredited doctor. Attention: for services rendered in private that are not listed in the WGKK tariff list, the WGKK cannot reimburse any costs.
Since 2015, there has been the option to apply electronically via the WGKK website. For this, you need a readable scan or a photograph of the respective invoice in electronic form, as well as the mobile phone signature or citizen’s card.
The following documents are required for reimbursement of costs for treatment by non-accredited doctors:
A detailed invoice with a clear description of the medical services rendered (date of the examinations, home visits, special services, diagnosis and the doctor’s/facility’s stamp.
Proof of payment ("payment received” note on the invoice, payment slip, bank statement, bank transfer acknowledgment by the bank).
- for MRT and CT examinations
- Referral – prior approval from the WGKK is absolutely essential!
- Reimbursement of costs is only possible with the following facilities: Dr. Bader MR Ambulatorium, MR Hansson Röntgen, CT Diagnosezentrum Margareten, CT Evangelisches Krankenhaus. If any other facility is used, no reimbursement of costs is possible!
Cost reimbursement is in any case excluded,
- if the treatment or examination is not a medical treatment in the sense of the General Social Security Act (ASVG)
- if the service rendered is not part of the WGKK’s official list of fees, or in the case of medication if the drug is not included in the reimbursement code (“Erstattungskodex”) of the Main Association of Austrian Social Security Institutions.
- if a contractual partner – including the WGKK’s health facilities – and a non-accredited doctor of the same field have been consulted in the same quarter (potential exceptions include first aid, change of residence and vacation/illness of the doctor in charge so far)
- if a doctor under contract is consulted in private
- if a doctor under contract is consulted in his or her private practice (secondary establishment)
- if treatment takes place in a hospital out-patient department financed by the Regional Health Fund, e.g. Hanusch hospital, AKH, Rudolfsstiftung (addresses)
- if without the Fund’s approval more than one non-accredited doctor of the same field was consulted in a quarter and if facilities under contract for MRT and CT examinations were consulted privately.
- According to the WGKK guidelines, prescribed physiotherapeutic treatment has to be received within a month from the date of issue of the Health Fund’s approval. The treatment should be finished within a quarter if possible, but in any case by the end of the following quarter at the latest.
More information on non-accredited doctors:
Telephone: +43 1 601 22-2720