Services and Costs

Who covers which decision?


Cost of Orthodontic Treatment for Privately Insured Patients

In the past, the conditions in private health insurance (PKV) were wonderful. PKV offered its mostly young, healthy and well-off policyholders generous comprehensive cover for little money, with little attention paid to economic efficiency.

Unfortunately, these good times are over, because today private health insurers are increasingly checking whether a treatment is reimbursed at all and, above all, to what extent. There are great differences in reimbursement behaviour between the 48 private health insurers in Germany, which can range from continued generosity to refusal of everything possible in deliberate violation of the law.

So you have to try it out in detail by having a treatment plan drawn up by the orthodontist and submitting it. In the case of adults, the PKV will always ask for the diagnostic documents for assessment, but this is also becoming increasingly common in the case of children. The experts commissioned by the PKV are, of course, not neutral, but are in an official or contractual relationship with the PKV. The expert reports often look like this.

More often than to dispute the necessity of treatment, the private health insurance companies engage in petty fights about the amount of the billing, especially about the increase factors and their justifications. These disputes are unfortunately increasingly burdensome for doctors and patients.

According to the current fee schedule, doctors in private health insurance can be billed many times more than those in statutory health insurance (SHI). In recent years, however, this difference has been increasingly equalised by private co-payments in SHI.

Due to the decreasing willingness of the PKV to reimburse, privately insured persons must slowly get used to the fact that a certain part of the costs must be borne by them privately. Treatment costs can range from 1000 € for straightening two front teeth to well over 10000 € for complex treatments for adult patients.


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