Cost of Orthodontic Treatment
Coverage in the Public Health Insurance
In Germany orthodontic treatment is covered by public health insurance until the 18th birthday, The severity of the findings is rated according to the orthodontic indication groups (KIG): f. ex. the public health insurance covers the treatment of two front teeth which deviate more than 3 mm towards each other or if the horizontal overbite of incisor teeth is larger than 6 mm. The treatment of smaller misalignments is considered a personal matter and has to be financed by the patient. The assessment is done by the orthodontist.
Public health insurance only covers standard treatments which are characterized with the words “suitable, economical, sufficient”. However, orthodontics has undergone a rapid development in the last decades and offers many modern treatment options which are not covered by public health insurance. Strictly speaking a modern, efficient orthodontic treatment is not possible at the average fee offered by the public health insurance price of 3500 Euro, considering that twice the amount was paid before 1990.
Additional Payments
For this reason, most orthodontists charge customers of public health care extra costs, which range from a few hundreds to 3000 Euro. Unfortunately it is almost impossible for patients to figure out the relation between claimed cost and offered service. This led to a non-transparent market of additional services.
With 2000 € additional payment we offer an optimal orthodontic treatment for the legally insured: almost exclusively fixed appliances, very short treatment duration, little trouble, top results.
Without Additional Payment
If parents do not want to make this additional payment, we naturally offer orthodontic treatment without it, which then of course must strictly comply with the provisions of the public health insurance – “suitable, economical, sufficient”. This usually means that a larger proportion of the treatment is performed with removable appliances, and the duration of treatment is about 3-4 years as it is common in Germany.
Coverage in the Private Health Insurance
Until the year 2000, private health insurance (PHI) was a paradise. PKV offered its mostly young, healthy and well-off policyholders excellent comprehensive coverage for little money, while hardly any attention was paid to economic issues. Unfortunately, these times are gone.
Today, private health insurance increasingly analyzes if a treatment will be covered at all and, first of all, to which extent. There are significant differences in refunding which can range from widespread generosity to denying anything though being aware of legal infringement.
Private health insurance always requests the diagnostic documents of adults in order to let them assess by a judge put in charge by their side, but this procedure is also becoming more and more common for treatments of children. The assessors authorized by the private health insurance are indeed not neutral but have a contract with and work for the insurance – which shows in the assessments.
Conflicts about Billing
More often than when the necessity of treatment is disputed, conflicts arise in private health insurance about billing, especially the increase factors and their justifications. Reimbursement for individual services is often refused on the grounds that they are not medically necessary or – very popular – cannot be billed at all, i.e. the orthodontist may only provide the planned service free of charge. These disputes are increasingly burdensome for orthodontists and patients – but unfortunately unavoidable.
If you want to know the exact amount of reimbursement for orthodontic treatment, it will be necessary to have a treatment plan prepared by the orthodontist and to submit it to the PHI. Without a treatment plan, you will receive only general and non-binding information.
Pay some Costs on your own
n addition, the point value (i.e., the basic price) in private health insurance has not been increased since 1988, while wages and prices have roughly doubled during this time. For this reason, the increase factors must regularly be set at up to 3.5 times the basic rate, and increasingly often well above this. Due to these increases and the decreasing willingness of the PKV to reimburse, privately insured persons must increasingly get used to the fact that a certain part of the costs must be borne by them privately.
The total treatment costs can range from 1000€ for the straightening of two front teeth to well over 10000€ for complex treatments of adult patients. A deductible of between 10-50% of the treatment costs is regularly expected today.
Orthodontics Costs in the State Aid System
Most subsidies have aligned their reimbursement behavior with that of the statutory health insurance funds. Thus, the principle of the statutory health insurance that “expedient, economical, sufficient” applies to the aid area. Patients entitled to benefits are thus privately insured, but can expect only modest reimbursements for their benefit portion.
Internal regulations, the so-called aid regulations, even exclude the reimbursement of many services altogether. For these reasons, a high deductible must almost always be expected for the aid portion.
Self-Payers - Without Insurance Coverage
If neither public nor private health insurance covers orthodontic treatment, as is increasingly the case, patients become self-payers. With these, the price of treatment can be freely agreed without regard to any payers and their bureaucracy.
Since there is no correspondence with cost units and simplified billing for self-payers, self-payers are valued in our orthodontic practice in Mannheim and can expect a somewhat lower price than would be usual for PKV patients.
In addition, we always offer self-payers an interest-free installment payment.