Health insurance Stricter checks by dentists

New billing system and stricter control over dental treatment costs

10/04/2012

The statutory health insurance companies want to take more control of the billing system of dentist costs. The fee rates of the dentists are to be more strictly controlled and the performance of patients by the statutory health insurance be reviewed, reports the "Süddeutsche Zeitung" with reference to a end of March by the Advisory Board of the GKV-Spitzenverbandes adopted position paper.

The non-transparent billing system, invoices that exceed the cost estimate and the increasing share of patients' own contribution costs, are a cause for the GKV to demand a stricter control of the dentist bills. The statutory health insurance companies also require permission to check the part of the bill that insured persons have to pay out of their own pocket. This would help the patients and increase transparency, so the statement in the position paper of the GKV-Spitzenverbandes. In addition, according to the report of the "Süddeutsche Zeitung", the advisory board also advocated the introduction of a price catalog which is intended to regulate the additional payment of the legally insured person to the dentist.

Stricter control and more transparency in the dental bills required
With the adopted position paper, the advisory board of the GKV-Spitzenverband demands a stricter control and more transparency in the dental billing. In the future, the statutory health insurances want to check the billing of the approximately 54,000 dentists in Germany in a much more accurate manner, and in so doing take a close look at the patients' own contribution. And for good reason, because since the introduction of the fixed subsidy for certain dental services under the red-green federal government in 2005, the proportion of the cost price for legally insured dentist patients has risen steadily. For reasons of cost, the federal government had introduced the fixed subsidy at that time, which merely covers the standard treatment. However, the standard treatment often does not meet patients' expectations of adequate treatment, so that, for example, they insist on higher quality ceramic fillings instead of the cheap (but controversial) amalgam fillings. The patients have to pay the cost difference out of their own pocket. The additional benefits are billed according to the fee schedule of private health insurance (PKV) and are usually much more expensive. The GKV-Spitzenverband here assumes an increase in the patient's own contribution of between 2005 and 2009 of up to 14 percent.

Costly of the legally insured for dentist treatment increased considerably
In the past years, for example, the treatment of dentists has become significantly more expensive, without the benefits having improved significantly. According to a survey of the alternative health insurance companies, in 2009 about 76 percent of all dental prostheses were billed on the basis of the private fee schedule. In doing so, the patient's own contribution often exceeded even the proportion of statutory reimbursement. For the patients a considerable financial burden, which has led also to a multiplicity of complaints with the independent patient consultation (UPD). Therefore, the deputy chairman of the GKV-Spitzenverbandes, Johann-Magnus von Stackelberg, in conversation with the "SZ" "finally transparency in the dental bills." The patients were left here alone and could not judge to what extent an invoice for dental services was appropriate.

Health insurance companies want to control dental treatment costs
The problem is in the opinion of the GKV-Spitzenverbandes that the health insurance companies pay the fixed subsidy, but "never get the actual bill that the patient receives for the private share," explained Johann-Magnus von Stackelberg. "Today's system is intransparent and leaves the insured with the private invoice for the dentures alone," von Stackelberg continues. In the future, therefore, according to the decision of the Administrative Advisory Board of the GKV-Spitzenverband, the private share of a dental bill should be checked by the health insurance funds. In this way, the health insurance companies can control, "if the patient does not have to pay too much," said the deputy chairman of the GKV-Spitzenverbandes. It remains unclear to what extent the statutory health insurance claim additional contributions for this review of dental bills.

New billing system planned for additional services at the dentist
In addition to the stricter control of the billing should be developed according to the plans of the GKV-Spitzenverbandes also a copayment catalog for the dental treatment of the legally insured. The health insurance companies want to set up a new billing system, in which no longer the fee catalog of private health insurance is based, but a separate price catalog for the additional payments of legally insured forms the basis. In this way, the dental treatment costs of legally insured could be significantly reduced, so the opinion of the GKV-Spitzenverbandes. Although additional payments would still be due with the introduction of the new billing system, this could be kept substantially lower than previously, explained von Stackelberg.

Dentists see political calculation in the proposals
Dentists think nothing of amending the recently reformed tariff. There is no legal basis and no political majority for the project, says the chairman of the Federal Dental Association, Dr. med. Jürgen Fedderwitz. Rather, this is an "Easter egg, which was us as a profession," said Fedderwitz. Rather, the proposals go in the direction of politics, in order to raise more, for possible times after the upcoming federal election. "Perhaps, so Fedderwitz, want the cash" already in the parties, with which such demands may be expected or expected to prepare the bed and the mood. "The health insurance, however, do not accept the criticism. In the field of vision of her work are not the dentists but the 70 million cash patients whose interests one wants to take care of, Florian Lanz of the Federal Association of health insurance companies. (Fp)

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Picture: Claudia Heck