Dentist of Choice or Panel Dentist

Blog >> Dentist of Choice or Panel Dentist >> Dentist list

To subscribe enter email here please:




Dentist of Choice or Panel Dentist

Long waiting times for the next appointment, no time for your questions – whoever has already been annoyed by an issue like this when looking for a dentist appointment, has definitely at least considered to opt for a dentist of choice over a panel dentist. But which costs does one have to expect in such a case? How much do you expect to get in return from insurance companies? Read more about this topic in the following blog post.

Index

What is a dentist of choice?

In general, a dentist of choice does not have a contract with the insurance company that underwrites your policy. Many dentists of choice, however, do have contracts with certain insurers, such as the SVA or the BVA, because those allow them to offer a broader spectrum of procedures than a contract with the regional health insurance fund.


Dentist of choice is highly concentrated during a treatment

Dentist highly-concentrated during a treatment
 

Which treatments does a dentist of choice offer?

If your dentist is a dentist of choice, he or she generally offers more treatments than a panel dentist This is because panel dentists have to adhere to a strictly defined catalog of services that they receive from insurers. New, innovative treatment methods are, thus, often offered only by dentists of choice. Also, they can spend more time on individual treatments and on answering questions from their patients because the duration of an initial consultation is not predetermined in the same strict way as it is for a panel dentist (namely, by the insurance company).

How does billing work for a dentist of choice?
After receiving treatment by a dentist of choice, a patient must pay the bill that he or she receives in the office or via mail out of pocket and may then send the bill on to a health insurer for any potential reimbursement. Some dentists of choice even offer to submit open invoices for reimbursement to health insurers without involving their patients. Then, the patient gets reimbursed for a part of the costs - to be exact, for 80% of the amount that a panel dentist receives for the same service. Caution! Not 80% of the invoiced amount, but 80% of the reimbursement that insurers pay panel dentists - this is crucial to remember because invoices from dentists of choice are usually for higher amounts than they would be from panel dentists. 

Additionally, insurers reimburse only for services that they cover for panel dentists as well - and those are specified in their so-called treatment spectrum. Procedures that do not fall into said spectrum are those that have not yet been deemed medically necessary, such as permanent tooth replacements (e.g., dental bridges), for which patients have to pay entirely out of their own pockets. A dental cleaning is an additional procedure of this kind, for which patients have to pay entirely out of their own pockets. 
 

Which dental procedures are paid for by insurance?
Among the most important services that are reimbursed by insurers are: 

  • Dental procedures
  • Removable tooth replacements & braces
  • „Free braces“ and „free dental cleanings“ for children and young adults of up to 18
What is crucially important to keep in mind is that some insurers do require a copay of 25-50% for removable tooth replacements and braces. In the case of fillings, insurers also do not cover every kind of filler - for example, for more expensive materials (e.g., white composite filling, gold), patients sometimes need to pay a copay. Only fillings made of amalgam that are placed in the non-visible part of the mouth and some newer-type fillings placed in the visible part of the mouth are covered 100% by insurers.

Therefore, patients are advised to inquire with their insurers which costs they will likely have to cover out of their own pockets before undergoing a more extensive and expensive dental treatment. With some insurers - for example the BVA and SVA - you have to pay a copay for dental procedures.  


A dentist of choice is about to make a diagnosis

Dentist issuing a diagnosis

Which dental procedures are not paid for by insurance? 
Private dental treatments that are not covered by insurers (and for which patients have to pay out of their own pockets) include:

  • Permanent tooth replacement & permanent braces
  • Cosmetic dental treatments
  • Professional dental cleaning
What is also crucial to remember: per quarter, insurances generally pay only for services of a single dentist of choice from one specialty (irrespective of the number of visits) - therefore, if you visit two different medical providers of choice in a given quarter, insurers do not pay for the costs for the second one!

In Summary: The Pros & Cons of dentists of choice
Dentists of choice generally offer a broader spectrum of procedures and take more time for their patients - also, they usually have more open availabilities.

However, it is often difficult to correctly assess ahead of time, which costs a patient will face and how much he or she will get reimbursed. Also, the patient has to, at first, cover 100% of the bill right after the procedure is completed.

Should someone plan to visit dentists of choice more frequently, it is advisable to obtain a wrap-around, private insurance policy: Such a policy also covers higher cost amounts for dental procedures than governmental insurers. 


In the meantime, we would love to hear from you – please leave any thoughts and feedback in the comment box below and get a free subscription to our blog to stay abreast of our latest stories.





Any questions?
Send us a message