Surprise charges and paying for English: Expats sound off on Czech doctors' hidden fees

Navigating a foreign healthcare system is tricky and often fraught with difficulties: learning about a new insurance system, finding a doctor, and overcoming language barriers are just some of the hardships that expats in Czechia may face when moving to the country.

However, one controversial practice – the Ministry of Health recently announced plans to counter it – is the habit of unnecessarily charging patients with hidden or extra doctors’ fees.

We asked you whether you have ever encountered this and in which context. Concerningly, many readers replied, telling us about their experiences of being charged surprise fees in various types of doctor’s offices – including gynecologists, dermatologists, and general practitioners. 

Expats.cz also contacted legal experts to get their views on whether charging extra fees is legal. We found that many readers complained of extra fees for the most basic of things – such as registering with a practice, using standard supplies for a procedure, and just speaking English.

Answers have been edited for length and clarity.

A large proportion of respondents mentioned they had been charged extra fees in gynecology-related practices 

“My gynecologist wanted a fee of about CZK 800. They told me in advance that this was their annual membership fee and that it was for having a profile on their site, which I ‘need.’  I didn't have a chance to say no to a fee, because I had a hard time finding a gynecologist who would speak English,” reader Tjaša told us.

Another reader – who is covered by state insurer VZP – experienced similar. “I had to pay CZK 1,000 to register with my gynecologist. I will also soon be going to a hospital for essential surgery, and I had to pay over CZK 5,000 in advance. I also had to buy my own compression stockings, which I understand is common here, but uncommon in my home country,” said Emma.

Similarly, reader Aileen recalled how she had to pay a CZK 500 annual fee for her gynecologist. She added: “I knew about it beforehand. Everyone, foreigners and locals, has to pay it.” Another woman commented: “My gynecologist told me there was a registration fee for a year, which covered two check-ups. These should have been free. I was not told about this beforehand.” 

Paying added fees just for being able to communicate an English – a so-called English-speaking fee – is also a pervasive problem for foreigners in Czechia, our survey shows.

Reader Ryan told us that when visiting his allergist he needed to pay CZK 500 per appointment just to speak English. “The doctor's English wasn't even very good, and I wound up using a mixture of English and Czech,” he said to Expats.cz. Another reader said they visited a VZP-accepting doctor’s office that charged CZK 500 per visit just to be able to speak English, which was “virtually non-existent.”

One mother wrote that, when making an appointment for a psychiatrist for her son, she needed to pay “double.”

Paying an extra fee for an English-speaking service was a common trend – judging by readers’ responses, prices range from CZK 200 all the way up to CZK 600 to communicate in English. 

Sadly, the trend of paying extra is not limited to the gynecology field. People visiting specialists in dermatology and allergies also experienced unwelcome, extra fees.

“A dermatologist asked me to pay for an annual CZK 500 ‘reception fee.’ I had no idea before that I would need to pay anything – I thought all would be covered by VZP,” reader Agnieszka told us. 

“I was surprised to learn that my dermatologist and allergy clinic charges a yearly fee for so-called "premium services," including confirmation of appointments via SMS. I was not aware of this before and I refuse to pay without any hesitation or doubts. However, they continue to try and persuade me during every visit,” said Martin.

Ryan, who in the past visited an allergist, told us that his allergist charged him CZK 250 just to have his test results e-mailed to him. 

Paying extra for supplies needed during routine procedures is also a worrying phenomenon. 

“I went for a gastroscopy and was charged CZK 500 so that the doctor could use CO2 to inflate my stomach during the procedure instead of standard air (according to them, CO2 is more comfortable and the body expels it quicker). I was told that the fee was mandatory and non-negotiable. I was completely unaware of the fee beforehand,” said one reader. 

“A gynecologist charged me for ‘one-time use supplies,’” added another person. 

“It turned out that even though I have doctor’s recommendation for a breast ultrasound, I had to pay an extra CZK 1,000 – I did not expect this,” reader Eve told Expats.cz.

Is all of this legal, though? The short answer is: it depends. There are a lot of gray areas when it comes to charging extra fees for patients. 

Expats.cz reached out to laywer and specialist in healthcare law, Barbora Steinlauf, on the issue. “Healthcare providers may not demand payment from the patient for services already covered by health insurance – this would be a so-called double payment, which is against the law and breaks the contract between the provider and the health insurance company,” she said.

Expats.cz also spoke with lawyer Jiří Gorčík, who specializes in private law. “The whole issue of doctor’s fees is problematic. The fees may mean that the paying patient is treated instead of the non-paying one, even though the latter has exactly the same right to treatment," he told us.

Another lawyer, Jiří Melkus of Melkus Kejla & Partners, said: “Doctors may request payment for a service that is not covered by public insurance or if the doctor does not have a contract with the insurance company for a specific service.”

On the topic of registration fees, lawyer Kristýna Pintová of the Pak & Švehelka law firm damningly told Expats.cz that doctor’s offices in Prague should not be charging any sort of sign-up fees.

“Doctors justify the collection of fees by additional services that are not covered by a health insurance company, which they can – and such behavior is difficult to punish. However, doctors should not condition admission to care upon payment of a fee,” she added.

“We recommend that patients contact their health insurance company, the Ministry of Health, the relevant regional authority and, if applicable, the Czech Medical Chamber” if they are charged extra fees, Pintová notes.

Czech Health Minister Vlastimil Válek spoke out against the rogue fees in a recent interview in Czech media outlet iDnes, promising an end to them. His plan is to establish a clear, definitive list that details what types of services doctors can – and cannot – charge for.

The Health Ministry has said that it intends to ban registration fees once and for all. It also wants to totally eradicate the process of “priority ordering,” whereby doctor’s offices offer appointments sooner to people who are insured with a company that has a contract with that office.

Válek wants to punish violations with a fine of up to CZK 1 million for inappropriately charging extra fees. Válek says that he wants to have a “solid legislative basis” for the list by the end of the government’s current term (around October 2025). 

However, one important caveat would remain, though. The authorities would only be able to take action if someone complains to them about unauthorized payments – and this rarely happens. The Ministry of Health specifically notes that “the cooperation of all concerned actors is needed,” to bring about punishment. 

“After discovering any unfair fees, patients should turn their complaints to the [health insurance] provider and then to the relevant regional health office,” ministry spokesperson spokesman Ondřej Jakob affirmed.