Those with statutory health insurance have one major advantage: They hardly ever get bills from their doctors – it is sufficient to present your dental insurance billing card and the billing is done between the doctor and the insurance company. Exceptions are, of course, additional services that are not borne by the health insurance companies.
If supplementary dental insurance is taken out so that you do not have to bear these additional services in full yourself, the principle of reimbursement applies: you undertake to pay the dentist for these additional costs, i.e. you are a contractual partner. You then submit the invoice to your supplementary dental insurance company for reimbursement.
And don’t worry: Most dentists give you payment terms of 30 days and more – so you don’t have to pay in advance and advance the invoice amount, but can submit the invoice and then pay the invoice after reimbursement by the supplementary dental insurance.
Treatment and cost plan for reimbursement for dentures
Those with statutory health insurance must submit a treatment plan and cost plan to their health insurance company before starting dental prosthesis treatment. This shows the health insurance fund what measures the dentist is planning, what costs are incurred, and it is, therefore, the basis for deciding which subsidies the health insurance company will provide. The treatment and cost plan is standardized:
Section I (findings/treatment plan)
In this area of the treatment and cost plan (also referred to as HKP for short), a tooth chart serves as the basis for the dental findings, the possible standard care, and the actually planned care.
Section II (Findings for Fixed Grants)
The findings are noted here, on the basis of which the fixed allowances are later calculated by the health insurance company.
Section III (cost planning)
In this area of the HKP, the customer receives an overview of the expected treatment costs based on the dental fee and the material and laboratory costs. If private services are planned, the customer will receive an additional statement of costs in part 2 of the treatment and cost plan.
Section IV (subsidy determination)
This is where the health insurance company becomes active and enters the fixed subsidy amounts – it is also noted whether and to what extent you are entitled to a bonus. After this step, the treatment at the dentist can begin.
Section V (invoice amounts)
The actual invoice amounts from the dentist are entered here later, on the basis of which the dentist bills the cash register. As a patient, you will also receive an invoice from your dentist for your own contribution.
Part 2 of the treatment and cost plan (appendix to the HKP)
In this appendix, the patient can see what costs he will incur if he wants a treatment that deviates from the benefits covered by the health insurance and through which he incurs his own costs.
Some supplementary dental insurance plans stipulate in their conditions that the HKP must be presented to the supplementary insurance company before the start of treatment – at least if the treatment is expected to cost more than 1,000 euros. If this is the case with your contract, make sure not to miss it, otherwise, the reimbursements will be reduced.
Dental insurance: a reimbursement for dental treatment on account
Depending on the contractual agreement, the supplementary dental insurance also covers dental treatment or prophylactic treatments. In order to be able to submit and be reimbursed, a treatment and cost plan is not required. The costs will be reimbursed at the agreed percentage upon presentation of the relevant invoices.
Get your money faster: Submitting the invoice with the invoice app
More and more dental insurance companies rely on an invoice app for reimbursement. With this app, you scan a code on your dentist bill and transfer it directly to your insurance company. You no longer have to submit the original invoices and save time and money on postal delivery. In addition, such invoices are automatically checked and thus reimbursed much faster.
The first bill is always the hardest…
If you have supplemental dental insurance, you will eventually use it for the first time. The “first time” may be that the reimbursement takes a little longer because the first invoice is always extensively checked. As a rule, the dentist is written to and has to answer a questionnaire. The background: When you signed the contract, you had to answer health questions about your dental status – and with the first reimbursement, the moment has come when the supplementary dental insurance checks this information.
