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ForumsInternationalGerman private insurance (PKV) vs statutory (GKV) — need advice

German private insurance (PKV) vs statutory (GKV) — need advice

Dr.CardioMD Mon, Dec 22, 2025 at 9:52 AM 8 replies 1,074 viewsPage 1 of 2
Dr.CardioMD
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Dec 22, 2025 at 9:52 AM#1

The list price and the price I actually pay differ by a factor of six depending on which of four routes I use, and none of that is transparent from the outside.

The bit I cannot resolve on my own is what actually works on a prior-authorisation denial, as opposed to the list of things that sound like they should work.

If the honest answer is that nobody knows, that is a useful answer and I would rather have it.

22 17kim_atl_prep, sarah_TO, wendy_avl and 19 others
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DanielChem_CHI
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Dec 22, 2025 at 10:25 AM#2
Dr.CardioMD said:
The list price and the price I actually pay differ by a factor of six depending on which of four routes I use, and none of that is transparent from…

Telehealth prescriber review for cost and coverage: I've used 3 different telehealth platforms to get my GLP-1 prescription. Comparison:

FeaturePlatform APlatform BPlatform C
Initial Consult$55$85$0
Monthly Follow-up$35Included$55
Prescription SpeedSame day24-48 hoursSame day
Lab MonitoringRequiredOptionalRequired

I settled on the one that required labs — it shows they care about safety, not just prescribing volume.

21 16Dr.DermMIA, fiona_VT, denise_HTX and 18 others
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Dr.GastroMayo
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Dec 22, 2025 at 10:58 AM#3
DanielChem_CHI said:
Telehealth prescriber review for cost and coverage: I've used 3 different telehealth platforms to get my GLP-1 prescription.

Insurance update relevant to cost and coverage: I just got my prior auth approved through Anthem after 4 attempts.

What finally worked: a letter from my endocrinologist documenting BMI history (>3 years), failed diet attempts, comorbidities (NAFLD + metabolic syndrome), and referencing the SURMOUNT trial data.

If your PA keeps getting denied, don't give up. Request a peer-to-peer review between your doctor and the insurance medical director. That's what finally broke through for me.

20 15COA_Karl, MikeFit_NJ, InsuranceTom and 17 others
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BiostatsBrad
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Dec 22, 2025 at 11:31 AM#4
Dr.CardioMD said:
The list price and the price I actually pay differ by a factor of six depending on which of four routes I use, and none of that is transparent from…

Second this. The detail I would add is minor and it is already implied above.

19 14james_edin, FranDenver, Dr.BariatricHTX and 16 others
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Dr.Martinez
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Dec 22, 2025 at 2:34 PM#5

Clinical perspective, offered as context rather than as advice.

My insurance denied my PA related to cost and coverage. Has anyone successfully appealed? I'm considering going compounded instead.

Last edited: Dec 22, 2025 at 7:34 PM
18 13adam_van, Dr.SurgeonPGH, rachel_ABQ and 15 others
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