An implant as a private patient – and paying in instalments
What German private health insurance reimburses, why the treatment and cost plan belongs before treatment, how the state allowance and supplementary dental insurance play in, and the two routes to paying in instalments.
Implants are part of the benefits catalogue of German private health insurance – diagnostics, placement and the restoration all appear in the fee schedule for dentists. How much is actually reimbursed is not laid down in law but in the individual policy: depending on the tariff, rates range from half to full reimbursement, in some cases with ceilings during the first years. One step is decisive, costs nothing and is often skipped: submitting the treatment and cost plan before treatment begins.
What private health insurance reimburses
Three things determine the amount: the treatment and cost plan, the insurer's reimbursement system and the individual policy. Even a plan drawn up correctly under the fee schedule can be reduced – over multiplier rates, over laboratory costs, or over services the insurer classifies as not medically necessary. Knowing that in advance means it can be discussed before treatment starts.
Submit the plan beforehand – always
The treatment and cost plan should be with the insurer before the first step of treatment. It contains every foreseeable item: diagnostics, any bone grafting, the implant components including the manufacturer, the surgical work, laboratory costs and fitting the new teeth. The written reply to it is what can be relied on later. Anyone who submits only after treatment is negotiating about an invoice that already has to be paid.
Civil servants and the German allowance scheme
Those entitled to the state allowance have two addresses: the allowance office and the private insurance covering the remainder. Both assess separately, and both want to see the plan in advance. The allowance scheme follows its own rules, which differ from insurers' tariffs – so one may pay while the other reduces. Here too: obtain two written replies before the first appointment takes place.
Supplementary dental insurance: not retroactive
Supplementary dental insurance can absorb a large part of the patient's own share. But it only helps if it was already in place. Missing teeth and treatments already recommended are as a rule excluded, and many policies have waiting periods and ceilings in the first years. Anyone who already knows about a gap will no longer receive reimbursement for it – for future teeth, taking out a policy may still be worthwhile.
Paying in instalments through the practice
Many practices agree to payment in parts, often without interest. That is an arrangement between patient and practice and is not laid down anywhere; you have to ask for it, it is not always offered of its own accord. Two routes are common: the invoice is issued per stage of treatment – surgery, then prosthetics – or the total is spread over several monthly instalments. Either way it should be put in writing.
Financing through a provider
The second route runs through a billing or finance company the practice works with. The practice receives its money, the patient pays the company in instalments. That works and is widespread – but it is a credit agreement with everything that entails: a credit check, a term, an annual percentage rate. Three things therefore belong before the signature.
- What is the total amount at the end, not the monthly instalment?
- What annual percentage rate is stated in the contract?
- What happens if the treatment takes longer than planned?
The order of steps that saves money
Little can be changed about the sum itself, quite a lot about the order. Submitting the plan in advance means knowing your own share before deciding. A bonus booklet kept without gaps earns a higher fixed allowance under statutory insurance – twenty per cent more after five years, thirty after ten. And spreading treatment over two calendar years can, under some supplementary policies, use two annual budgets instead of one; whether that applies to your own policy is stated there and nowhere else.
What the plan has to contain
A plan meant to support reimbursement has to be verifiable. If an item is missing, it is submitted later – and items submitted afterwards are the most common point of dispute.
- every service with its fee number and its multiplier rate
- diagnostics and, if planned, the bone grafting as separate items
- the implant system and manufacturer by name
- laboratory costs stated separately
- the prosthetics up to the finished crown, not just the surgical part
Under statutory insurance: what is different
For those with statutory insurance there is no reimbursement of the implant but a finding-related fixed allowance based on the standard restoration. The rest is the patient's own share – and that share is exactly the amount where instalments or financing are worth discussing. In a few precisely described exceptional cases the insurer covers more.
Who draws up the plan
A sound treatment and cost plan follows the clinical findings and the planning, not a telephone call. The directory on this portal lists practices with a focus on implantology – by location and qualification, without ranking and without rating.
Answered briefly