For many self-paying international patients, the financial process is: medical review first, preliminary treatment plan second, cost estimate third, advance payment before the confirmed appointment, and final settlement after actual care. The exact rules differ by hospital, but this pattern is published by several major German university centers.
The estimate follows medical review
UKE states that the International Office sends existing medical reports to the responsible department for a treatment proposal and then prepares the estimate based on the treatment plan and German billing systems. Heidelberg similarly sends a treatment offer and cost calculation after specialists review the submitted medical information.
Why the estimate is preliminary
LMU explains that exact costs are rarely predictable before treatment because complexity and additional services can change. Heidelberg calls its calculation preliminary and notes that the actual diagnostic and therapeutic measures ultimately required may differ from what was expected from the records submitted before travel.
Advance payment is common
LMU requires advance payment according to the estimate because it does not directly bill foreign health insurers in this pathway. UKE describes prepayment before scheduling and embassy confirmation, and Heidelberg links confirmed appointments for visa purposes to receipt of the advance payment stated in the estimate.
What happens after treatment
Final settlement can go in either direction. UKE describes refunding a remaining balance where applicable. Heidelberg states that an unused balance is refunded, while complications or additional care can lead to a further payment requirement.
Before transferring money
Use only payment instructions issued through the hospital's verified official channel and make sure the patient/case reference is correct.
- Confirm the beneficiary is the hospital or authorized official entity
- Verify bank/payment instructions using the hospital's official contact route if anything looks unusual
- Keep the cost estimate and payment receipt
- Ask how overpayments and additional charges are settled
- Do not pay a third party merely because it claims to have a hospital appointment slot
Official sources
Last source-reviewed 2026-08-29. Administrative, insurance, reimbursement and visa rules can change. Follow the current instructions of the responsible hospital, insurer or public authority before acting.