Private dentist

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A private dentist is a resident dentist who does not take part in contract dental care . In contrast to the contract dentist ( statutory health insurance ), he has no registered office and is not licensed by a statutory health insurance association (KZV) . A private dentist treats all patients regardless of their insurance status. However, the statutory health insurance companies do not reimburse any treatment costs, even in emergencies. In the case of private patients, beneficiaries and statutory health insurance patients with private supplementary insurance, reimbursement is based on the insurance tariff.

The basis for billing services by a private dentist is always the fee schedule for dentists (GOZ). This follows from § 612 BGB, according to which if there is a rate - the GOZ is considered a rate - this is to be applied. In particular, it is subject to Section 1 (2) GOZ:

The dentist may only charge remuneration for services that are necessary for dental care according to the rules of dental art. He may only charge for services that go beyond what is necessary for dental care if they have been provided at the payer's request.

Services "on demand" are z. B. purely cosmetic measures (bleaching, rhinestones ...). These are not covered by insurance.

In addition, the dentist is subject to professional supervision. The basis for this is the professional code of the Dental Association, to which it must be a member by virtue of the law ( Medical Professions Chamber Act ).

The private dentist must announce his branch to the responsible dental association . In addition, he must be registered with the responsible health department . The private dentist is one of the liberal professions in Germany , just as it is one of the liberal professions in Austria .

There are around 500 private dentists in Germany (as of 2012).

Private dental patient

In contrast to the statutory health insurance patient, who reveals themselves as such by presenting their health insurance card or electronic health card, a treatment contract is concluded - usually implicitly - between the dentist and the private patient . This does not affect a possible. Insurance contract for private patients with private health insurance (PKV). Limitations of the insurance tariff (e.g. limitation of the rate of increase or price list for dental services) do not need to be taken into account by the dentist in the billing.

As a secondary obligation under the treatment contract, the dentist has the duty to support the patient with the reimbursement. He should therefore prepare a cost estimate for more extensive (more expensive) treatments and inform the patient that he should obtain a declaration of cost coverage from his private health insurance company. However, the dentist's obligations do not go so far as to have the patient submit the insurance contract or the cost assumption declaration from the private health insurance provider or to advise him on insurance law. This is also the case with the large number of private dental insurance tariffs on the market, the different contractual clauses, different amounts of deductibles , waiting times , graduated tariffs, tariff exclusions, individual benefit exclusions and much more. not possible.

Over half of all private patients are eligible. Grab here different aid guidelines, which are difficult for a patient. Here, too, there are exclusions from benefits, reimbursement restrictions and different aid rates.

Statutory insured persons can - waiving their entitlement to benefits in kind from statutory health insurance - also be treated as private patients. They are also called " self-payers ".

Invoice and reimbursement transparency

The GOZ billing regulations are complicated even for professionals, so that ultimately the patient can hardly check the correctness of a GOZ bill himself. A reputable practice will explain the bill in an understandable way if so desired.

Overall, there is a lack of reimbursement transparency for the individual insured, so that the insured can only provide the insured with at least a rough overview of the reimbursement benefits and know what deductible he or she has to pay.

In addition, there are different interpretations of the GOZ provisions by the private health insurance companies on the one hand and the dental associations on the other. This applies above all to innovative services that are not yet included in the GOZ.

Grant policies are often difficult for a patient to understand. Here, too, there are exclusions from benefits, reimbursement restrictions and different aid rates.

Target performance principle

See main article Target performance principle .

The target performance principle is a term from the private fee schedule for doctors (GOÄ) or the private fee schedule for dentists (GOZ) and aims to avoid double fees for medical services. In Section 4 (2) GOZ, which has been in force since January 1, 2012, it says: “The dentist cannot charge a fee for a service that is part of or a special implementation of another service according to the fee schedule, if he charges a fee for the other service. This also applies to the individual operational steps that are methodically necessary to provide the operational services listed in the schedule of fees. A service is a methodologically necessary component of another service if its content is included in the service description of the other service (target service) and has also been taken into account in its evaluation. "

Medical malpractice

When suspicion of treatment failure in private dentistry medical private opinion may help.

The following are possible for out-of-court clarification:

However, the procedure before an arbitration board only gets underway if the accused dentist agrees to the arbitration procedure.

In addition, the civil courts are open for judicial clarification .

See also

Individual evidence

  1. ↑ § 612 BGB
  2. ↑ Bavarian Medical Professions Act, accessed on August 24, 2012
  3. ^ Federal Dental Association, 2012 yearbook

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