What the health and cost plan says - "roadmap" for the treatment

Two crowns and one inlay - that's what Karin Bäumer decided on after a detailed consultation with her dentist. Before the treatment begins, the dentist issues the appropriate treatment and cost plan (HKP), which the patient subsequently submits to her statutory health insurance.

How much does the health insurance pay?

Once approved, the "timetable" for the therapy is fixed. "For dentures and orthodontic treatments, a treatment and cost plan is always created first, " explains Dr. med. Rüdiger Butz from the proDente initiative. "He describes the planned treatment, sets the budget and must be approved by the health insurance before the dentist can start work."

With the grant, the fund also sets the grant that it provides for treatment. Because Karin Bäumer and the HKP submit a bonus book filled in over the required time, she receives a 30 percent bonus from her health insurance for her fixed subsidy. The approved plan is now valid for six months, by which time the treatment must be completed.

Diagnosis and treatment plan in one

The HKP describes findings and treatment suggestions in one - and he works with numerous abbreviations, all of which are explained on the form. "Nevertheless, it is not easy for the patient to understand every detail, so do not be afraid to ask the dentist or his staff, " Dr. Butz. Karin Bäumer has also explained the plan. She can read the situation in her mouth, the "dental status", in the so-called "dental plan" of the HKP. Each tooth is marked with a number

Lower case letters describe the condition of each tooth: "f" stands for "tooth missing", for example, "k" means "crown present". Also noted in the tooth scheme are the abbreviations in capital letters for the planned treatment: Here "E" stands for "tooth to be replaced", Karin Bäumer's desired crowns with metal-ceramic veneer are marked with "KM".

Costs in estimates

The resulting costs are also part of the HKP. In the section "Fee Advance Calculation", the individual dental and dental technical measures are indicated, however, encrypted by number combinations, which Karin Bäumer can also explain in the dental practice. The cost of each step is not indicated as a price, but also with valuation numbers multiplied by a point value. Karin Bäumer can orient herself at the sum listed below for the dental services.

In addition, an amount for the expected material and laboratory costs for the dental services is given. "These prices are basically only estimates, which are based on the average amounts for a comparable treatment, " said Dr. med. Butz. "Precisely, the costs can not be predicted in advance." Each denture is unique, which is made especially for a particular patient, as in our case for Karin Bäumer, and no mass-produced goods is always the same and always costs the same.

Therefore, a new situation may arise during the therapy, which may require a modified - and possibly more complex - treatment. If such a correction is also necessary for Karin Bäumer, the dentist discusses the new measures with her and enters them as "additional services" at the HKP, which documents the entire treatment. However, not all benefits can be retroactively entered into the HKP, in some cases it must be newly created.

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