what procedures are covered by public health insurance?

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Hello,

 

So recently I got a job in Frankfurt and got my public health insurance by BARMER GEK.

I know that there are already many topics about how to find some good doctors that could be covered by the insurance, but I wanted to know if the insurance covers also some treatments, or also just visits.

For example, I need dental root canal treatment which could get quite pricey and I would like to know if there is a chance to expect that it could be covered?

 

Thank You! 

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dental work and vision is only partially covered (example eye doctor covered glasses not) Root canal you can expect to chip in a few hundred euros, varies on what you need and dentist my quote was around 500 euro. 
 

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56 minutes ago, valerija said:

Hello,

 

So recently I got a job in Frankfurt and got my public health insurance by BARMER GEK.

I know that there are already many topics about how to find some good doctors that could be covered by the insurance, but I wanted to know if the insurance covers also some treatments, or also just visits.

For example, I need dental root canal treatment which could get quite pricey and I would like to know if there is a chance to expect that it could be covered?

 

Thank You! 

When you received your card, plus info on the Kasse, you should have a list of what is covered.  Or call them, check their website.

Some dental work has to be pre-approved- your dentist will submit an estimate.

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Dental work is what is almost not covered by public insurance (but you still give the card to the dentist, some things are covered), but some Krankenkasse offer supplementary dental insurance for a reasonable price (e.g. Envivas by TK).

 

Given that root canals or tooth implant are pricey here, it makes sense to look for such an insurance.

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As I understand it, the gesetzliche Krankenkassen have to cover certain things, but after that, they can choose what else they want to offer their clients.

Best to contact your KK and simply ask them!

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...any doctor can do it as well. Actually, even better to ask the doctor, they know what exactly needs to be done and can show you what costs will be covered by Krankenkasse. For a simple filling ~50% of the price is covered (unless you want amalgam filling). Check-ups twice a years can be covered, too (depends on Krankenkasse). Also some KK offer more coverage if you do 1/2 year checks for 5 years or more.

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I'm with Barmer GEK (and only have good experiences with them). I'd been having pain on and off in a tooth for years and having suffered at the hands of the butcher dentists of 1980's Scotland was loath to go to a dentist. Stupid me. Anyway, on point - I found an excellent dentist, but on further inspection not only did the painful tooth need to be removed there was subsequent problems with the surrounding teeth. So much so that I needed a crown and a small bridge. The dentist said he would write to Barmer GEK etc.- they agreed to pay quite a substantial part, I only paid about 420 euros for top quality work.

 

Make sure you have a good dentist - plenty of review sites out there. That's the most important thing. My dentist explained to me about writing to the Health Insurance and everything that came after.

 

Hope it all gets sorted!

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Hello, guys!

i also do wonder what does state insurance cover and how to get full list of services.

 

I have Audi BKK (they based in Bavaria). On their website they have list of services, but it is not very detailed.

So I have send an email asking them how do I know what is covered and what is not.

 

They have answered:

"bitte suchen Sie kassenzugelassene Ärzte auf.

Diese sind dazu verpflichtet, bei entsprechender medizinischer Indikation die notwendigen Untersuchungen als Sachleistung zu erbringen.

Das heißt, die von Ihnen angefragte Prüfung nimmt der Arzt vor."

 

So nothing is clear still.

 

Before I used to get answers from doctors: they would tell me what is covered. But last time I was at dentist (in Berlin) girls at reception were not that sure. Also the Dentist himself said that my insurance will cover only amalgam filling but for composite I should pay 50 Euro extra. However in Bavaria I got composite for free (though very bad done). 

 

So I would love to see the list of services to know my rights. That is ridiculous that we are obliged to have insurance and pay big money for that but the answers are still vague and unclear. Seems like German insurance is a pretty complicated thing, so even doctors are confused. 

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Yes, john g., i checked it out.

As said, there is some info, but far not everything, e.g. which type of filling is paid etc. 

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Just returned from a 2 hour session from my dentist.

First I had to wait 1 hour because of an emergency. No problem for me, since two month ago, I was the emergency.

A filling had to be replaced. She asked me what quality and I said the best. She said that that would cost me 120€.

No problem, if the tooth survives some more years. I sat on the chair with my mouth open for more than one hour!

So, 120€ was not that expensive. I have the impression that she works slow but carefully.

I think, she would go bancrupt if she only gets the money from the Krankenkasse.

The 120€ tip was well spent. I don't want to search for a new dentist.

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The health insurance covers the filling itself but with cheap materials, currently they pay only for amalgama (nobody want them anymore) or the cheapest cement. What you paid was the difference for the better materials, I had one replaced a couple of weeks ago because it broke and went there as an emergency, I as well requested the best materials and they told me I had to pay 30 EUR per "portion" and mine was a big one so I had to pay 3x, total 90 EUR. I assume your's was even bigger and you paid 4x.

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Yes, I also have been told to pay the difference (between amalgama which covered and composite which is not). The price named is 50 euro per tooth. I have no idea if price is good or not.

I just have read, that state insurance should cover composite filing on front area teeth (cause amalgama is silver color). That is why I was not charged before for composite - it was on front teeth. However, new doctor wants me to pay even for front area. May be cause he wants money for good job; he said previous filling were put bad. And article also says that for extra layers you can be charged even when works are done in front teeth.

 

If anyone else paid recently for composite fillings, share how much. And did you get free of charge for front ones?

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Some more expensive services need to be "genehmigt" by KK, my doctor sent a request for a new crown, the KK agreed to pay 77 euros, I paid 207. If you show regular 5 or 10 years yearly dental visits (I didn't, what an idiot!) then KK will pay more.

 

Implantat is not covered at all, you need Zahnzusatzversicherung for that.

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Just wait until you need to cap a front tooth and then see how the prices change. My dentist knows exactly what I have covered to what extent by my health insurance. His office provides an itemized quotation upon request which includes the part which health insurance would cover. I see the bottom line of my expected costs and choose my treatment (basically choose which materials should be used) based on the bottom lines.

Dentists do very good business and get very good money. A decent practice will provide you with quotes and options if you ask for them.

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1 hour ago, Smorodina said:

That is why I was not charged before for composite - it was on front teeth. However, new doctor wants me to pay even for front area. May be cause he wants money for good job; he said previous filling were put bad.

 

That's probably because you took the free/cheap composite instead of the good stuff and it failed.

Just goes to show, you get what you don't pay for.

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2 hours ago, AnswerToLife42 said:

Are there still dentists who work with amalgam?

My dentist told me, she did not do for years.

 

I guess if you're on Hartz IV you are stuck with it. So, there definitely must be dentists who work with amalgam.

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