Dental implants: reimbursement under the German GOZ and GOÄ scales
Reimbursement of implant treatment by private health insurers on the basis of the treatment and cost plan.
Before treatment
The treatment and cost plan
Where reimbursement is concerned, the concept of medical necessity plays a special part. In principle the cost of implant treatment is covered by the benefits catalogue of private health insurers: diagnostics, placing the implants and the prosthetic superstructure are all part of the German scales of fees for dentists and doctors (GOZ and GOÄ) that govern reimbursement.
Everything turns on the treatment and cost plan, the insurer's reimbursement system and the individual insurance contract in which the separate items are regulated. Before implant therapy, your dentist sets out the cost of the planned treatment in the treatment and cost plan. It contains every foreseeable item: treatment costs, diagnostics, any bone grafting, the implant components and their manufacturer, the surgical work, laboratory costs and fitting the new teeth.
The plan has to be approved by the insurer before treatment begins. Even where it is drawn up on the basis of the German scales of fees, a private insurer can refuse to cover certain items. The small print of contracts often contains numerous clauses restricting cover for particular implant treatments. Some tariffs limit the maximum number of reimbursable implants, others the insurer's contribution.
The key points at a glance
- Reimbursement of implant treatment is in principle part of the benefits catalogue of private health insurers.
- Diagnostics, placing the implants and the prosthetic superstructure are all part of the German scale of fees for dentists.
- What matters for reimbursement are the treatment and cost plan and the individual insurance contract.
Answered briefly