Quotation Estimate Ophthalmologist in Germany Frankfurt –Free Word Template Download with AI
Frankfurt Eye & Vision Center GmbH
Goethestraße 42, 60311 Frankfurt am Main, Germany
Phone: +49 (0)69 1234 5678 | Email: [email protected]
USt-IdNr.: DE 123 456 789 | HRB 45678 Frankfurt am Main
Germany Frankfurt – Licensed Ophthalmology Practice1. Purpose and Scope of This Quotation Estimate
This Quotation Estimate has been prepared by the Frankfurt Eye & Vision Center GmbH to provide a detailed, transparent, and itemized cost overview for the full spectrum of Ophthalmologist services that will be rendered to the patient listed above. As a certified Ophthalmologist practice operating in Germany Frankfurt, we are committed to ensuring that every patient receives a clear financial breakdown before any diagnostic or therapeutic procedure is initiated. This document serves as a formal Quotation Estimate in accordance with the German Medical Fee Schedule (Gebührenordnung für Ärzte – GOÄ) and the applicable regulations of the State of Hesse (Hessen).
The Ophthalmologist services outlined below encompass a comprehensive ophthalmic evaluation, advanced diagnostic imaging, potential surgical intervention, and post-operative follow-up care. All pricing reflects the current fee structure for an Ophthalmologist practice in Germany Frankfurt and includes applicable statutory health insurance (GKV) or private health insurance (PKV) reimbursement considerations where applicable.
2. Itemized Ophthalmologist Services and Costs
| No. | Description of Ophthalmologist Service | GOÄ Factor | Unit Price (EUR) | Quantity | Total (EUR) |
|---|---|---|---|---|---|
| 1 | Initial Ophthalmologist Consultation & Comprehensive Eye Examination (visual acuity, refraction, intraocular pressure, slit-lamp biomicroscopy) | GOA 100 (×1.0) | € 85.00 | 1 | € 85.00 |
| 2 | Advanced Diagnostic Imaging: Optical Coherence Tomography (OCT) of the retina and optic nerve | GOA 355 (×1.35) | € 120.00 | 1 | € 120.00 |
| 3 | Dilated Fundus Examination with Fluorescein Angiography (performed by the Ophthalmologist) | GOA 356 (×1.35) | € 145.00 | 1 | € 145.00 |
| 4 | Anterior Segment Ultrasound (B-Scan) for posterior segment evaluation | GOA 357 (×1.35) | € 95.00 | 1 | € 95.00 |
| 5 | Phacoemulsification Cataract Surgery with Premium Intraocular Lens (IOL) implantation – Ophthalmologist surgical fee | GOA 401 (×2.3) | € 1,850.00 | 1 | € 1,850.00 |
| 6 | Premium Toric Intraocular Lens (IOL) – material cost | Material | € 420.00 | 1 | € 420.00 |
| 7 | Post-operative Ophthalmologist Follow-up Visits (3 visits: Day 1, Week 1, Month 1) | GOA 100 (×1.0) | € 65.00 | 3 | € 195.00 |
| 8 | Prescription of Post-operative Medications (antibiotic drops, anti-inflammatory drops, lubricant drops) | Material | € 48.00 | 1 | € 48.00 |
| 9 | Operative Room Fee & Anesthesia (topical + intracameral) – Germany Frankfurt facility charge | Facility | € 380.00 | 1 | € 380.00 |
| 10 | Administrative & Documentation Fee (Quotation Estimate processing, medical records, insurance billing) | Admin | € 35.00 | 1 | € 35.00 |
| Subtotal (before VAT): | € 3,373.00 | ||||
| VAT (19% – USt): | € 640.87 | ||||
| Grand Total (Quotation Estimate Amount): | € 4,013.87 | ||||
3. Insurance and Reimbursement Notes
Please note that this Quotation Estimate reflects the full private-pay cost structure for the Ophthalmologist services described. In the event that the patient holds statutory health insurance (gesetzliche Krankenversicherung – GKV) in Germany Frankfurt, the responsible insurance carrier will reimburse a portion of the listed fees according to the applicable benefit catalogue (Leistungsverzeichnis). Premium IOLs, certain diagnostic imaging modalities, and elective surgical enhancements may be subject to partial or full patient co-payment (Selbstbeteiligung). The Ophthalmologist team at our Frankfurt practice will coordinate directly with the patient's insurer to confirm coverage prior to scheduling any procedure.
4. Terms and Conditions of This Quotation Estimate
- Validity: This Quotation Estimate is valid for 30 calendar days from the date of issue. After this period, pricing may be adjusted to reflect changes in material costs, GOÄ fee updates, or facility charges in Germany Frankfurt.
- Payment Terms: 50% of the total Quotation Estimate amount is due upon scheduling confirmation. The remaining 50% is payable within 14 days following the completion of all Ophthalmologist services, including the final post-operative visit.
- Cancellation Policy: Cancellations made more than 72 hours before the scheduled surgical procedure will incur no additional charges. Cancellations within 72 hours will be subject to a 20% administrative fee on the total Quotation Estimate.
- Scope Limitation: This Quotation Estimate covers only the Ophthalmologist services explicitly listed in Section 2. Any additional procedures, complications, or extended hospitalization not anticipated at the time of this estimate will be subject to a separate, supplementary Quotation Estimate issued by the treating Ophthalmologist.
- Regulatory Compliance: All services are performed in full compliance with the German Medical Profession Act (Berufsordnung für Ärzte), the Hessian State Medical Association regulations, and the data protection requirements of the GDPR (DSGVO) as applicable in Germany Frankfurt.
- Warranty: The Ophthalmologist practice provides a 12-month clinical warranty on the surgical outcome. Any re-intervention required within this period due to surgical complications will be performed at no additional cost to the patient.
5. Acceptance and Authorization
By signing below, the patient (or authorized legal representative) acknowledges receipt of this Quotation Estimate for the Ophthalmologist services described herein and authorizes the Frankfurt Eye & Vision Center GmbH to proceed with the scheduled care plan. The patient confirms that all information provided in this document has been reviewed and understood.
For the Patient / Insured Party
Signature & DateFor the Ophthalmologist – Frankfurt Eye & Vision Center GmbH
Dr. med. [Name], Facharzt für Augenheilkunde
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