Treatment only against private bill: The health insurance company AOK is in dispute with the Bavarian dentists. Patients will face complicated negotiations by the end of the year.
AOK policyholders in Bavaria face complicated negotiations with their dentists about additional services such as anesthetic injections or the replacement of discolored dental fillings by the end of the year. The reason is a financial dispute between the Kassenzahnärztliche Vereinigung Bayern (KZVB) and the general local health insurance company AOK Bayern. The Bavarian dentists only want to treat the insured of Bavaria's largest health insurance to a limited extent.
AOK health insurers should pay out-of-pocket benefits The KZVB has now announced so-called buffer days, during which the insureds of AOK Bavaria and two comparatively small regional insurance companies should be asked by the dentist to pay out-of-pocket benefits that are not medically necessary. Since the three health insurance companies mentioned do not provide enough money for comprehensive medical care, the dentists cannot be sure of numerous treatments during this time, the KZVB chairman, Janusz Rat, explained. In the past, the AOK had always added millions in 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. By the end of the year, AOK insured persons in Bavaria will likely have to forego services such as anesthetic injections or the replacement of unsightly fillings, or pay out of their own pocket. However, medically urgent treatments such as carious teeth, unusual fillings or acute toothache continue to be treated without any problems, emphasized Janusz Rat.
AOK Bayern sees misconduct on the part of dentists AOK Bayern, on the other hand, stated that it had fully met its payment obligations and that the dentists had incorrectly distributed the funds available. For example, AOK director Ulrich Resch from Ingolstadt warned the insured against accepting private dentists' bills, because the AOK would not reimburse them for legal reasons. Since the budget available has been used up, the dentists receive only a third of the usual rate for many treatments. In order to avoid a further escalation of the conflict, the AOK wants to call in an arbitration board that mediates between the insurance company and the KZVB.
Patients are the victims Independent of the outcome of the negotiations, the insured are once again the victims. The AOK advises in no case to accept private bills and the KZVB recommends that dentists only offer certain treatments against private bills. The insured are therefore facing lively discussions with their dentists about the necessity and timing of appropriate treatments. The insured of the company health insurance and replacement insurance such as Techniker Krankenkasse, Barmer or DAK are not affected by the planned buffer days. (fp, 11.10.2010)
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