A hip replacement (total hip arthroplasty) or knee replacement (total knee arthroplasty) means a return to mobility, independence, and quality of life for many people. For decades in Germany, those with statutory health insurance were treated almost exclusively in public hospitals, while private clinics remained reserved for privately insured patients. However, this is changing: An increasing number of publicly insured patients are gaining access to highly specialized private clinics , such as the curaparc-clinic Mainz or the LILIUM Clinic in Wiesbaden .

This article explains everything about the legal basis, the procedure for individual cost reimbursement , specific advantages compared to treatment in public hospitals, and why the curaparc-clinic Mainz, under the direction of Prof. Dr. med. Karl Philipp Kutzner, is the first choice for those with statutory health insurance.

What is individual cost coverage?

Individual cost coverage allows those with statutory health insurance to receive treatment in a private clinic without having to pay for the medical costs of the operation themselves. The patient submits an application to their health insurance company for coverage of treatment costs in a non-contracted facility. If this application is approved, the insurance company pays for the entire operation, provided the costs are comparable to those of a contracted hospital.

the ENDOPROTHETICUM has developed extensive expertise in handling these application procedures. The clinic actively supports patients in formulating and submitting the necessary documents. Many statutory health insurance companies are increasingly receptive to this form of care and approve coverage of treatment costs without restrictions.

Legal basis for the reimbursement of individual costs

The legal basis is provided by Section 13 of the German Social Code, Book V (SGB V). This section allows for reimbursement of costs in exceptional cases , for example, if the waiting time in a regular hospital is medically unacceptable or if specialized service providers are expected to offer better results. Section 73 of the SGB V (Special Care) and rulings by the Federal Social Court also strengthen the position of patients.

Step-by-step instructions for the application

1. Specialist medical indication by an orthopedist or trauma surgeon
2. Obtain a quote or cost overview
3. comparative cost estimates from a regular hospital
4. Justification : medical necessity, e.g., long waiting times, complex procedure
5. Submit an application to the health insurance company with supporting documents.
6. Wait for a response or file an appeal

The advantages of private clinics for those with statutory health insurance

• Planning security : fixed surgery dates without short-notice cancellations
• Fast appointment scheduling : Surgery often within a few weeks
• Specialized teams : often more experienced surgeons
• Individual care : Chief physicians provide personal care.
• Modern equipment : e.g., navigation systems, robotics

The problems of public hospitals in endoprosthetics

Many public hospitals suffer from:

• Staff shortage
• Surgery cancellations due to emergency room overload
• waiting times lasting months
• High staff turnover in nursing staff
• Increasing frustration among patients and relatives

Especially in endoprosthetics, scheduling is crucial, as many patients live with pain for months.

The advantages of private clinics in endoprosthetics for society

Integrating specialized private clinics into the healthcare system for those with statutory health insurance can also have positive effects on society as a whole. It relieves the burden on public hospitals, reduces waiting lists, and ensures more efficient use of existing resources. Especially in times of increasing staff shortages and hospital overload, this form of care offers a valuable addition. It promotes innovation, raises quality standards, and improves patient satisfaction across the entire healthcare system in the long term. Planning security : fixed surgery dates without last-minute cancellations.

• Fast appointment scheduling : Surgery often within a few weeks
• Specialized teams : often more experienced surgeons
• Individual care : Chief physicians provide personal care.
• Modern equipment : e.g., navigation systems, robotics

The curaparc-clinic Mainz: Endoprosthetics at the highest level

The curaparc clinic in Mainz is headed by Prof. Dr. med. Karl Philipp Kutzner , one of the leading specialists for hip and knee replacement surgery in the Rhine-Main region. As a certified endoprosthetics center, the ENDOPROTHETICUM :

• minimally invasive surgical techniques
• modern implants with long durability
• individual patient planning
• precise prosthesis positioning using navigation
• consistent follow-up treatment

Endoprosthetics at the renowned LILIUM Clinic in Wiesbaden

In addition to the curaparc-clinic, Prof. Dr. Kutzner also performs surgery at the renowned LILIUM Clinic Wiesbaden , another state-of-the-art private clinic in the Rhine-Main region. There, too, patients with statutory health insurance benefit from his expertise through individual cost coverage. The LILIUM Clinic also offers excellent infrastructure, short waiting times, and personalized care – thus representing first-class endoprosthetic care at the highest level.

The role of the endoprotherapeutic agent

ENDO-Reha takes place directly on the curaparc campus. There, patients are mobilized immediately after surgery by specialized rehabilitation therapists. This guarantees seamless transitions without the stress of transport and ensures measurably better rehabilitation results.

Testimonials from patients with statutory health insurance

Numerous people with statutory health insurance report positive experiences:

• "After months of waiting at the university hospital, finally help"
• "Finally, a doctor who took his time"
• "After two weeks I was back on my feet"

Efficiency and fairness

Private clinics ensure that treatment costs correspond to public rates to facilitate individual cost reimbursement. Only optional services such as a private room or a contract with the head physician are subject to additional charges.

Conclusion:

Even those with statutory health insurance can now benefit from the excellence of a private clinic. The curaparc-clinic Mainz and the LILIUM-Klinik Wiesbaden offer outstanding quality in endoprosthetics, short waiting times, and personalized care. Thanks to the individual cost reimbursement system, this option is accessible to many.

At ENDOPROTHETICUM, we are happy to advise you and support you with the application process, minimizing the burden on you as a patient. Get personalized information – for a new quality of life with a hip or knee replacement. Even those with statutory health insurance can now benefit from the excellence of a private clinic. 

Get advice – for a new quality of life with a hip or knee replacement.