Finding a doctor in Germany: the card, the Hausarzt and the referral myth

What do you need before you can book your first appointment?

Your electronic health card, and nothing else. § 291 (1) SGB V obliges the health insurance fund to issue an elektronische Gesundheitskarte for every insured person, and § 13 (1) sentence 2 of the Bundesmantelvertrag-Ärzte in the version of 1 April 2026 obliges you to present it before every use of a panel doctor. There is no registration step with an authority, no referral from anywhere, and no proof of address to produce first.

If the card has not arrived yet, and in the first weeks after an Anmeldung it usually has not, the fix runs through your insurer rather than the practice. § 19 (2) BMV-Ä allows the fund to issue a proof of entitlement instead of the card only in exceptional cases, to bridge the transition until you receive one, and requires it to be time-limited. Sentence 4 of the same provision says that at your request the fund transmits it directly to the practice as an elektronische Ersatzbescheinigung.

Turning up with neither is where it gets expensive, and the rule has a deadline built into it. Under § 13 (8) sentence 3 no. 1 BMV-Ä a panel doctor may charge you a fee only where the card was not presented before the first use in the quarter and is not supplied within ten days of that first visit.

That invoice is not final. § 13 (9) BMV-Ä requires a fee paid on that ground to be repaid if you present a valid card or a § 19 (2) proof to the practice by the end of the calendar quarter — so a private bill in week two is still reversible in week nine, as long as you go back with the card.

There is a separate question of whether the practice will treat you at all without a card. § 13 (7) sentence 1 BMV-Ä entitles a panel doctor to refuse an adult who presents neither the card nor an electronic substitute certificate, and sentence 2 removes that entitlement where there is akute Behandlungsbedürftigkeit — acute need for treatment.

How do you find a Hausarzt, and can a practice turn you away?

A panel doctor may refuse you only in justified cases. The wording of § 13 (7) sentence 3 BMV-Ä is that the Vertragsarzt may otherwise refuse to treat an insured person nur in begründeten Fällen, and sentence 4 entitles the doctor to tell the health insurance fund the reasons. The contract text does not say that a full appointment book is automatically such a case, and it does not say the opposite either — but it does mean that a practice saying no is applying a rule, not exercising a free choice, and asking politely which ground applies is a reasonable question.

Knowing who counts as a Hausarzt saves a wasted phone call. § 73 (1a) SGB V lists general practitioners, paediatricians and internists without a Schwerpunktbezeichnung who have opted into hausärztliche Versorgung, among others. An internist who has not opted in is a specialist, not a GP, which is why § 76 (3) sentence 3 SGB V requires participation in the hausärztliche Versorgung to be stated on the practice sign.

For the search itself there are two official routes. The Kassenärztliche Bundesvereinigung runs a nationwide doctor and psychotherapist search at arztsuche.116117.de, and § 75 (1a) sentence 3 no. 2 SGB V makes supporting insured people in finding the GP they want to choose under § 76 (3) sentence 2 a statutory task of the Terminservicestelle — the same service you reach on 116117.

Do this while you are healthy, and do it before you need anything. That is the one recommendation in this guide, and the reason is § 73 (1) no. 2 SGB V: coordinating your care, including arranging a specialist appointment that is urgently necessary on medical grounds, is part of what hausärztliche Versorgung means. A GP who already has your file is a different instrument from a stranger's answering machine on the morning you cannot stand up. Getting the arrival sequence right — Anmeldung, bank account, health insurance, then a GP — is one of the things our placement service organises with candidates, and it is free for you because the employer pays.

Two further provisions make the choice worth writing down rather than remembering vaguely. § 73 (1b) sentence 1 SGB V puts a duty on the providers who treat you to ask which GP you have chosen, and sentence 3 obliges a previous GP, with your consent, to transfer your complete records to a new one when you change.

Do you need a referral to see a specialist in Germany?

No, not as a general rule, and the belief that you do is the most persistent piece of wrong advice in English-language forums about the German system. § 76 (1) sentence 1 SGB V gives insured people a free choice among all doctors admitted to panel care, medical care centres and authorised institutions, and § 13 (3) sentence 1 BMV-Ä repeats it in the contract between doctors and funds.

Where a referral does decide something is when you want the Terminservicestelle to find the appointment rather than finding it yourself. § 75 (1a) sentence 4 SGB V requires a referral for the mediation of a specialist appointment, then carves out three exceptions: appointments with an eye doctor or a gynaecologist, cases following an outpatient emergency assessment at a hospital that found a need for treatment but no immediate necessity, and acute cases handled under sentence 3 no. 4.

In practice that referral carries a code. The KBV states that the Vermittlungscode is a twelve-character combination of letters and digits which entitles you to book through 116117 online or by telephone, that it comes from the referring practice, and that since October 2025 practices can generate it directly in their practice software and print it on the referral. On its own patient-service pages the KBV names the appointments that need no code at all: GPs, paediatricians, eye doctors, gynaecologists, and a first consultation in a psychotherapeutic Sprechstunde.

A different consequence follows from which doctor you pick rather than from any referral. § 76 (1) sentence 2 SGB V allows doctors outside panel care to be used only in emergencies, so a purely private practice is not a route into the statutory system with a bit of paperwork afterwards.

The same choice reaches into your sick pay. § 5 (1a) sentence 3 no. 2 EntgFG switches off the electronic sick-note procedure where the incapacity is established by a doctor who does not take part in panel care — the certificate then does not travel to your employer by itself, and producing it is back on you. What the sick note requires in general is set out in our guide on what German employers expect.

There is one open door in the list below. § 13 (5) BMV-Ä allows the Einheitlicher Bewertungsmaßstab to designate highly specialised services that require a referral because of the equipment or qualifications they need. If a practice asks you for one outside the listed specialties, that is the provision to ask about — not a general rule you missed.

Otherwise the obligation to bring a referral is a closed list rather than a principle. § 13 (4) sentence 1 BMV-Ä names the specialties that may be consulted only on referral:

• laboratory medicine, microbiology and infection epidemiology
• nuclear medicine
• pathology
• radiological diagnostics and radiology — with an express exception in sentence 2 for mammography screening, which you may attend directly
• radiotherapy
• transfusion medicine

How long can you be made to wait for an appointment?

The statute sets outer limits, and they bite once the Terminservicestelle is the one arranging the appointment. § 75 (1a) sentence 5 SGB V states that the waiting time for a treatment appointment may not exceed four weeks, and that for a mediated radiological appointment it may not exceed three. Sentence 3 no. 1 gives the service itself one week to arrange an appointment at all.

Distance is capped too, though only in words. Sentence 6 requires the distance between your home and the arranged doctor to be zumutbar, meaning reasonable, and leaves the detail to the Bundesmantelvertrag, differentiated by specialty.

The interesting sentence is the one about failure. § 75 (1a) sentence 7 SGB V provides that where the service cannot arrange an appointment with a panel provider inside the deadline, it must offer you an outpatient appointment at an approved hospital instead. § 76 (1a) SGB V then lets you use a hospital that does not take part in panel care at all, and covers the necessary follow-up treatment that secures the result.

That escape route has an exception worth knowing before you feel wronged by it. Sentence 8 disapplies it for postponable routine examinations and for Bagatellerkrankungen, meaning minor complaints, while expressly keeping scheduled children's health check-ups inside the guarantee.

Psychotherapy runs on its own track and needs no referral for the first step. Under § 75 (1a) SGB V the mediation of a first appointment in a psychotherapeutic Sprechstunde requires no Überweisung, and the waiting time for acute psychotherapeutic treatment may not exceed two weeks.

For scale rather than for promises: the KBV reported on 5 February 2026 that the Terminservicestellen mediated around two million appointments in 2025, against around 1.5 million in 2024, that more than a million of them were booked through 116117-termine.de or the app rather than by phone for the first time, and that acute cases can be given an appointment within 24 hours. You will find average waiting times quoted in the German press ranging from eight days to forty-two, depending on who was counted and how; no figure in that range is reliable enough to repeat here, which is why this section gives you the statutory deadline instead.

One whole branch of medicine sits outside all of it. Sentence 14 of § 75 (1a) SGB V excludes treatments under § 28 (2) and § 29 SGB V, dental and orthodontic care, from the appointment service, and 116117 says plainly on its own site that it does not cover dentists. For a dentist you call practices yourself, or the dental emergency service of the Land you live in.

Where do you go when the practice is closed?

Call 116117 for anything that cannot wait until the next surgery hour but is not life-threatening, and 112 when it is. The KBV's own wording on 116117.de is that in life-threatening cases you should alert the rescue service on 112, and the service describes itself as reachable 24 hours a day, seven days a week, free of charge from a German phone contract.

What sits behind the number is more than a switchboard. The service runs Bereitschaftspraxen, on-call surgeries staffed in the evenings, at weekends and on public holidays, and a Patienten-Navi that asks structured questions about your symptoms to recommend how urgent the situation is and where to be treated. The KBV states expressly that it makes no diagnoses.

That triage has a statutory basis, which is unusual for a telephone service. § 75 (1a) sentence 3 no. 4 SGB V requires the Terminservicestelle to arrange immediate medical care in acute cases at the medically appropriate level, on the basis of a nationwide, standardised assessment procedure, and in suitable cases by telephone consultation with a doctor.

Walking into a hospital emergency department instead is a decision with a price attached in the law. § 76 (1) sentence 2 SGB V permits doctors outside panel care to be used only in emergencies, and § 76 (2) SGB V puts the extra costs on you where you use somebody other than the nearest reachable panel doctor without a compelling reason. An emergency department is the right place for an emergency and a poor shortcut past a waiting list.

What do you actually pay?

Nothing at the practice. § 13 (10) sentence 1 BMV-Ä forbids a panel doctor to demand co-payments from insured people for panel services, with the single exception of massages, baths and physiotherapy provided as part of medical treatment. There is no consultation fee at the desk and has not been one for years.

Prescriptions have a fixed and narrow band. § 61 sentence 1 SGB V sets the co-payment at 10 percent of the dispensing price, at least 5 euros and at most 10 euros, and in no case more than the medicine itself costs — so a 3-euro medicine costs 3 euros, not 5.

A hospital stay is charged by the day and capped by the year. § 61 sentence 2 SGB V sets 10 euros per calendar day, and § 39 (4) sentence 1 SGB V limits that to at most 28 days per calendar year for patients over 18.

Above all of these sits a ceiling tied to what you earn. § 62 (1) sentence 2 SGB V caps co-payments at 2 percent of annual gross income used for living costs, and at 1 percent for the chronically ill in continuous treatment for the same serious illness. Sentence 1 obliges the fund to certify, once the limit is reached, that no further co-payments are due that year, and § 62 (2) sentence 1 adds together the payments and incomes of you, your spouse or partner and your minor or family-insured children living in the same household — which usually helps a family and is easy to miss.

What you will be asked to pay for is a different category, and it always arrives with a form. § 13 (8) sentence 3 no. 3 BMV-Ä permits a charge for services outside panel care only where your written consent was obtained in advance and you were told you would bear the costs; no. 2 covers the case where you yourself ask in writing to be treated privately. If somebody hands you a piece of paper to sign before an ultrasound described as a good idea, that paper is the reason it is not free.

What if you do not speak German yet?

You arrange the interpreting and you pay for it, and that is settled rather than uncertain. In its judgment of 23 January 2018 in case L 4 KR 147/14 the Landessozialgericht Niedersachsen-Bremen held that the SGB V contains neither an express provision on providing a language interpreter for medical examinations nor a power to create such a benefit by regulation or statute, and dismissed the appeal of a claimant who had interpreted for a cancer patient from Serbia at his doctor's appointments and radiotherapy.

The reasoning matters more than the outcome, because it explains why no health insurance fund will make an exception. The court read ärztliche Behandlung in § 28 (1) sentence 1 SGB V as covering what the doctor does personally, and the assistance of other persons under sentence 2 as covering only work the doctor can direct, supervise and answer for on the strength of medical expertise. In its words, nothing else applies to interpreters, because a doctor can neither direct nor check nor take responsibility for them. The court found no unplanned gap for the courts to fill, following the Federal Social Court's judgment of 10 May 1995 — 1 RK 20/94.

The one interpreting entitlement in social law does not reach this. § 17 (2) SGB I gives people with hearing or speech impairments the right to communicate in German Sign Language or with other suitable communication aids when social benefits are provided, and puts those costs on the responsible benefit provider. It is a disability provision, not a foreign-language one.

Which leaves the practical order of operations. Ask when you book whether the practice can treat you in English, rather than discovering it in the room; bring a German-speaking adult if the appointment is about something you cannot afford to misunderstand; and write down the medicines you already take by their active ingredient rather than their brand name, because brand names differ between countries and the active ingredient does not.