As you might know, the dental care billing procedure is based upon the dentists‘ fee schedule (GOZ - Gebührenordnung für Zahnärzte). The dentist’s allowance is composed of the treatment charge and expenses, e.g. for dental laboratory services. The dentist determines the treatment fee that may be
between 1.0 and 3.5 charge rates considering the
complexity and the
time invested as well as the entire
treatment situation.
The single (1.0) charge rate is not equivalent to the insurance fund charge fee as many patients believe. For instance, the insurance fund and social welfare rates are currently equivalent to 2.3 GOZ-charge rates. Having a one-root tooth extracted costs
3.93 € according to the single charge rate, while a social health insurance patient has to pay about
9.00 €, or 2.3 charge rates. If the extracting procedure is more complicated, the dentist can require a higher compensation. Additional costs have to be explained and documented.
However, to our private patients, virtually all treatments are available. In order to receive a good or a very good service, especially in estetic dentistry, the patients often have to pay
more than 3.5 charge rates. For these reasons, article 2 of the dentists‘ fee schedule specifically refers to „other charges“. This regulations is gaining in importance. In March 2011, The German Constitutional Court requested the dentists to use the „structuring options offered by the GOZ“. If a charge fee beyond 3.5 charge rates is necessary, I will inform you in advance so that we can agree upon the payment procedure together.
The GOZ also considers the development of new treatment methods. In case of such treatments, art. 6 „Analogue billing procedure“ has to be applied. Qualified service always requires adequate compensation which means that dentists and patients have to make an agreement according to art. 2 of the GOZ.
Even if your insurance fund promises you 100 per cent coverage, you should reckon with additional payments.
Alexandra Beau & team
.