Dispute between AOK & Dentists patients suffer

Treatment only against private bill: The health insurance AOK is in dispute with the Bavarian dentists. The patients will be faced with complicated negotiations by the end of the year.

AOK insured persons in Bavaria face complicated negotiations with their dentists about additional services such as anesthetic spraying or the replacement of discolored dental fillings by the end of the year. The reason is a financial dispute between the Kassenzahnärztlichen association Bavaria (KZVB) and the general local health insurance AOK Bavaria. The Bavarian Dentists want to treat the insured of the largest health insurance in Bavaria only limited.

AOK health insured persons should pay for services out of their own pocket
The KZVB has now called so-called buffer days, during which the insured of the AOK Bavaria and two comparatively small regional insurance companies, the dentist should be asked to pay medically not necessarily required services out of pocket. Since the three mentioned health insurance funds do not provide enough money for a comprehensive medical care, the dentists can not be sure at this time with numerous treatments of a corresponding payment, explained the KZVB chairman, Janusz advice. In the past, the AOK has always sent millions of dollars over the course of the year to fund the treatment of patients. This year, however, the insurance company refused to provide additional funds, Janusz Rat said. For example, by the end of the year, AOK insured persons in Bavaria will probably have to forego benefits such as stunning sprays or exchange unsightly fillings or pay them out of pocket. However, medically urgently needed treatments such as carious teeth, failed fillings or acute toothache continue to be treated without any problems, Janusz Rat emphasized.

AOK Bayern sees malpractice in the dentists
The AOK Bayern stated, however, that they had completely fulfilled their payment obligations and the dentists had distributed the funds available wrong. For example, the AOK director Ulrich Resch from Ingolstadt warned the insured against accepting private bills from the dentists because these would not be reimbursed by the AOK for legal reasons. As the budget provided is exhausted, for many treatments dentists receive only one third of the usual rate. In order to avoid further escalation of the conflict, the AOK wants to call in an arbitration board, which mediates between the insurance company and the KZVB.

Patients are the victims
Regardless of the outcome of the negotiations, the insured are once again the victims. Because the AOK advises in no case to accept private bills and the KZVB recommends the dentists to offer certain treatments only against private bills. For example, the insured will have lively discussions with their dentists about the need and timing of appropriate treatments. The insured persons of the company health insurance funds and substitute funds such as Techniker Krankenkasse, Barmer or DAK are not affected by the planned buffer days. (fp, 11.10.2010)

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Picture credits: schemmi