Dental patient advice

from Wikipedia, the free encyclopedia

The dental patient counseling of the Association of Statutory Health Insurance Dentists (KZVen) and (state) dental associations offers nationwide free and independent advice from dental experts. The offer is aimed at both statutory and privately insured patients . In the network of dental patient advice, dentists and employees of KZVs and chambers give advice free of instructions from third parties or economic interests.

The aim of the dental patient consultation is to inform and advise the patient in the context of a treatment. In addition, the counseling centers at state level are the point of contact for all questions and concerns that may arise in connection with treatments that have already been carried out. Patients can contact one of the on-site advice centers by phone, email, letter, fax or in person.

history

In the mid-1990s, the dental associations and the (regional) dental associations set up an objective and specialist dental patient advice service on their own initiative. This makes it one of the first institutionalized counseling services ever available to patients.

In 2002, health policy took up the issue of patient counseling in legislation. The dental associations and the (regional) dental associations have taken into account the increasing public importance of the topic by expanding their advice centers.

With the introduction of the fixed subsidy system for dentures for those with statutory health insurance in 2005, the KZVen also expanded patient advice to include a nationwide “second opinion model”. Since then, patients have had the opportunity, on the basis of an existing treatment and cost plan, to obtain a further opinion on treatment planning from their dentist free of charge and without obligation .

Structure and services

The statutory dental associations and (regional) dental associations have, among other things, the legal mandate to monitor the fulfillment of the dental contract and professional obligations of the dentists. They also have the task of appointing experts and seeking arbitration in the event of disputes in the course of their professional activities. The dental self-administration therefore takes on the statutory task of patient advice, as well as the establishment of an expert service. So-called arbitration boards for out-of-court settlement of disputes have also been set up at the (regional) dental associations.

The professional advice focuses on questions about dental care, e.g. B. new or alternative treatment methods, materials, possible allergies and risks of therapeutic interventions.

The counseling centers are also the point of contact for patients' questions about dental fees, for example about the services of statutory health insurance companies or about statutory private co-payments for certain forms of therapy. In addition, information is provided on billing for services in accordance with the private fee schedule for dentists (GOZ) . The advice centers also provide help with complaints about billing. The advice on dental questions is provided by dentists in the patient advice centers, who provide advice in line with the current state of dental science or give a second opinion on the basis of existing treatment and cost plans . In special cases, a dental examination is also carried out on site. In addition, specially qualified employees of the dental self-administration work in the advice centers. In particular, you will advise patients on issues that border on dental treatment, such as billing services.

Dental reports

For the area of ​​contract dental care there is an expert procedure contractually agreed between the National Association of Statutory Health Insurance Dentists (KZBV) and the GKV-Spitzenverband (GKV-SV) . With a planning report , the health insurance company can have an expert check before the treatment whether the planned treatment requiring approval is technically appropriate and can be subsidized by the health insurance company. If the patient complains about the replacement of dentures or crowns, the justification of the complaint is assessed in a defect report. The appraisers must be approved as contract dentists and appropriately qualified. Patients do not incur any costs in the case of contract dental expert procedures.

Private patients or patients with statutory health insurance who have made use of private services and suspect treatment errors can request an opinion from the (state) dental associations - the so-called private opinion - about the treatment carried out. The patient bears the costs for this.

The report checks whether the supply complies with the rules of dentistry. Independent dentists act as experts for this purpose. Expert guidelines stipulate what qualifications the experts have and how they must fulfill their duties.

arbitration

If an amicable solution cannot be reached between patient and dentist, the (regional) dental associations offer an out-of-court arbitration option for patients whose concerns cannot be resolved through an expert procedure alone . The arbitration procedure has the task of resolving disputes arising from the practice of dentistry in an amicable manner or - provided the parties agree to this - to make an arbitration award. In most countries, the arbitration boards are set up on a legal basis and are usually staffed by dentists and lawyers . As an alternative to arbitration, individual (regional) dental associations also offer mediation as a method of dispute resolution.

Second opinion on a planned dental prosthesis

Those with statutory health insurance can obtain a free second opinion on their dental prosthesis treatment from the dental advice center . For this, the treating dentist must already have a specific treatment plan in the form of a treatment and cost plan. The consultations are conducted by selected dentists. You are not allowed to treat patients who have advised you afterwards. This ensures that the advice is provided regardless of any economic interests of the consultant. The consultation includes a second opinion on a specific treatment and cost plan for dentures. The dentist explains the planned treatment, the benefits of the health insurance company and the costs that the insured person incurs in the form of his own contribution. He answers the patient's questions and, if necessary, shows alternative treatment options.

Evaluation and further development

Since 2016, the results of patient advice have been recorded and evaluated nationwide according to uniform criteria. This makes it possible to continuously develop the advice provided by the dental self-administration. The evaluation also provides information on possible problems in the dental treatment process and helps self-administration to counteract this with targeted measures at an early stage.

Web links

Individual evidence

  1. ↑ Background: dental patient advice, KZBV and BZÄK website
  2. ↑ Fixed grants for dentures , National Association of Statutory Health Insurance Dentists
  3. ↑ reorganization of the assessor system , zm-online.de March 16, 2014
  4. ^ Expert opinion , website for information on dentures
  5. ↑ Second opinion model for denture treatment , website information on dentures