Direktabrechnung mit der PKV

Direktabrechnung mit der PKV describes the arrangement in which a provider bills a private insurer directly for a service, so the insured person never pays up front. Three separate things happen in place of the usual payment:

1. The invoice goes to the insurer rather than to the customer.
2. The insurer settles that invoice with the provider directly.
3. The customer signs a release so the provider may send the data.

It is the opposite of the usual private arrangement, where the customer pays the provider and then decides for themselves whether to submit anything to their insurer.

The reason it exists is friction, because a person who has to pay at the counter and then file paperwork feels the cost twice. Some customers will decline a service they would otherwise take. Where direct billing is in place, the service feels to the customer like the reimbursed side of the pharmacy, and the provider is paid without chasing a private debt. That convenience is also the catch, because it only works where the insurer has agreed to it.

Direct billing is not a right and it is not a default, because it rests on an agreement between the insurer and the provider, or on a scheme the insurer runs. That agreement covers only the services it names. For pharmacy self pay services no such agreement is generally in place, so the default remains Privatliquidation. The customer is handed a Rechnung an den Selbstzahler, pays it, and submits it onward if they wish, though nothing about that submission is a promise of reimbursement.

The comparison worth making is with the physician side, where private invoices are issued under the GOÄ and insurers are accustomed to the codes it produces. A pharmacy does not invoice under that schedule, which is one practical reason a pharmacy invoice is harder for an insurer to process automatically.

The reimbursed side of the business works differently again. The Packungsfixum rises from 8,35 to 9,00 euro on 1 July 2026 and to 9,50 euro on 1 January 2027, and that increase is set by law rather than negotiated by any individual pharmacy.

If a pharmacy wants to pursue direct billing, it should ask a specific insurer about a specific service and get the answer in writing. That answer needs to state what must appear on the invoice and what consent must be recorded. The tax treatment does not change with the payment route, because it depends on the service, and it belongs with your Steuerberater before the first invoice.