Health insurance companies: stricter controls by dentists

Health insurance companies: stricter controls by dentists

New accounting system and stricter control over dental treatment costs

Statutory health insurers want to take more control over the dentist's billing system. The dentists' fee rates are to be checked more strictly and the patient's personal contributions are also to be checked by the statutory health insurers, reports the "Süddeutsche Zeitung", referring to a position paper approved by the administrative advisory board of the GKV umbrella association at the end of March.

The non-transparent billing system, bills that significantly exceed the cost estimate and the ever increasing share of the patient's cost share are reasons for the GKV to demand a stricter control of the dentist's bills. The statutory health insurance companies also ask for permission to check the part of the invoice that the insured must pay out of their own pocket. This helps the patient and increases transparency, according to the statement in the position paper of the GKV umbrella association. In addition, according to the report of the "Süddeutsche Zeitung", the administrative advisory council also advocated the introduction of a price catalog, which should regulate the additional payment of the legally insured to the dentist.

Stricter control and more transparency required for dentist bills With the agreed position paper, the administrative advisory board of the National Association of Statutory Health Insurance Funds demands tighter control and more transparency in dentist bills. In the future, the statutory health insurance companies want to check the accounts of around 54,000 dentists in Germany much more closely and also take a closer look at the patient's own share. With good reason, because since the introduction of the fixed subsidy for certain dental services under the red-green federal government in 2005, the share of prime costs for legally insured dentist patients has risen continuously. At the time, the federal government introduced the fixed subsidy for cost reasons, which is only intended to cover standard treatment. However, the standard treatment often does not meet the patients' expectations of adequate treatment, so that they insist on higher-quality ceramic fillings instead of the cheap (but controversial) amalgam fillings. Patients have to pay the difference in costs out of their own pockets. The additional services are billed according to the fee schedule of private health insurance (PKV) and are usually significantly more expensive. The National Association of Statutory Health Insurance Funds assumes that the patient's own share will increase by up to 14 percent between 2005 and 2009.

Cost of legally insured persons for dental treatment has risen considerably In recent years, dental treatment for legally insured persons has become significantly more expensive without the benefits having improved significantly. The patient's own contribution has risen continuously and, according to a survey by the replacement health insurers, around 76 percent of all dental prosthesis services were billed in 2009 on the basis of the private fee schedule. The patient's own contribution often even exceeded the statutory reimbursement. A considerable financial burden for the patients, which has also led to a large number of complaints with the Independent Patient Counseling Service (UPD). Therefore, the deputy chairman of the National Association of Statutory Health Insurance Funds, Johann-Magnus von Stackelberg, in an interview with the “SZ”, “finally asked for transparency in dental bills.” Patients were left alone here and could not judge to what extent an invoice for dental services was appropriate.

Health insurance companies want to control dental treatment costs According to the GKV umbrella association, the problem is that the health insurance companies pay the fixed subsidy, "but never see the actual bill that the patient receives for the private portion", explained Johann-Magnus von Stackelberg. "The current system is non-transparent and leaves the insured alone with the private bill for the dentures," von Stackelberg continues. In the future, according to the decision of the administrative advisory board of the GKV umbrella association, the private part of a dentist bill will also be checked by the health insurance companies. In this way, the health insurance companies can check "whether the patient does not have to pay too much," emphasized the deputy chairman of the National Association of Statutory Health Insurance Funds. It remains unclear to what extent the statutory health insurance companies claim additional contribution funds for this review of the dental bills.

New billing system planned for additional services at the dentist In addition to the stricter control of the bills, a catalog of additional payments for the dental treatment of the legally insured is also to be developed according to the plans of the GKV umbrella association. The health insurance companies want to set up a new billing system, which is no longer based on the PKV fee catalog, but is based on a separate price catalog for the additional payments of those insured by law. In this way, the dental treatment costs of the legally insured could be significantly reduced, according to the GKV head association. Von Stackelberg explained that additional payments would still be due with the introduction of the new accounting system, but this could be kept much lower.

Dentists see political calculation in the proposals The dentists think nothing of a change in the recently reformed fee schedule. There is no legal basis and no political majority for the project, says the chairman of the National Association of Statutory Health Insurance Dentists, Dr. Jürgen Fedderwitz. Rather, it is an “Easter egg that has been inserted into our profession,” said Fedderwitz. Rather, the proposals go in the direction of politics, in order to line up more, for possible times after the upcoming Bundestag election. "Perhaps, according to Fedderwitz, the coffers want" already with the parties, with whom such demands are perhaps expected to be heard or hoped for to prepare the bed and the mood. ” The health insurance companies, however, do not accept the criticism. The focus of her work is not the dentists but the 70 million health insurance patients whose interests you want to take care of, Florian Lanz from the Federal Association of Health Insurance Companies. (fp)

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