Caries: what costs are covered by the health insurance company, tooth costs

Caries: What costs does the health insurance cover??

The essentials in brief:

  • Anyone who is covered by statutory health insurance is entitled to a supplement-free filling.
  • The basic therapy is completely covered by statutory health insurance companies, i.e. amalgam in the posterior region and composite (plastic) in the anterior region.
  • Anything that goes beyond the non-payment variant must be paid for yourself with a written additional cost agreement.
  • There is a two-year warranty on fillings.

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What is the standard treatment for tooth decay??

Fillings are benefits in kind in statutory health insurance, which means that what is necessary and economical is paid 100 percent. In the posterior area, the health insurance companies cover the costs for an amalgam filling, in the visible area for tooth-colored composite fillings. However, the till service only covers the single-layer technology, not the multi-layer technology, so the composite is filled and hardened in one step. Because composite (ceramic-reinforced plastic) shrinks during curing, the multi-layer technology is safer, in which several layers harden one after the other.

Dentists who do not use amalgam have to offer a free of charge contract alternative in the posterior region. That should be a "proven and practical plastic filling material" his. No more is specified. Due to their limited shelf life, cement fillings are more of a temporary and not a long-term alternative.

How are alternatives billed??

If you, as a legally insured person, want a more elaborate filling, include one with the dentist written additional cost agreement from (§28 Abs. 2 SGB V). Example of a more complex filling: In the posterior region, a tooth-colored filling, i.e. composite instead of amalgam, or in the anterior tooth region, a multi-layer plastic filling.

The additional cost agreement is only effective if it is from the insured and is signed by the dentist. Verbal agreements are ineffective, with the result that the patient then does not have to pay (see judgment of the Freiburg Regional Court of October 12, 2006). Patients should also make sure that all individual services, including the fee number, factor and the respective amount, are listed in the additional cost agreement.

Billing is based on the private fee schedule for dentists (GOZ). The statutory health insurance companies cover part of the costs, namely in the amount of the comparatively inexpensive filling formed in the tooth. The patient receives an invoice for the difference to be paid.

What are the exceptions for allergy sufferers??

At a proven The statutory health insurance companies pay for layered composite fillings in the posterior region of amalgam allergy. Even in cases of severe renal insufficiency, composite fillings in the posterior region are cash benefits. The health insurance then pays a subsidy equal to the cost of a plastic filling. Statutory health insurance companies do not replace intact fillings.

What happens if there are filling defects?

According to the law, dentists are obliged to be liable for defects in fillings and dentures (§136a (4) SGB V). This is called a guarantee and means that fillings or dentures can be repaired or replaced free of charge, provided the patient is not to blame for the defect. The guarantee is valid for two years from the time of insertion.

If there are problems with a filling, patients should therefore speak to the dentist and give him the opportunity to touch up, if necessary several times. Only if the problem cannot be solved should those affected contact the health insurance company. The guarantee only applies to the dentist who started the work.

If milk fillings or dental neck fillings have to be replaced within two years, this is also free of charge, but is not covered by the warranty, but the dentist can bill the checkout again as a repeat fill. The same applies to more than three-surface fillings and in cases in which special circumstances (such as previous illnesses such as bruxism) exist.

More on the subject:

Types of tooth fillings – Patient information of the Federal Association of Statutory Health Insurance Dentists

Fillings – Information for patients from the Kassenzahnärztliche Vereinigung Nordrhein

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Christina Cherry
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