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Will the costs be reimbursed by my health insurance?

Will the costs be reimbursed by my health insurance?

The reimbursement of costs relating to orthodontic treatment depends on the precise nature of the (tooth’s) defective position and on the type of insurance: public or private. With public insurance, treatment with a brace is generally only allowed until a person’s eighteenth birthday. Up until that time, the so-called scale of orthodontic indicator categories (KIG) is applied. Using these guidelines, each case that is potentially covered by insurance is described in detail. For example, an overbite problem in the molars must be greater than 6mm or the deviation of two crooked neighbouring teeth must be greater than 3mm in order for the costs to be reimbursed by the insurance company. Beyond the age of eighteen, orthodontic treatment is only covered by private insurance. There is only one possible exception for adult patients: if the teeth are so badly out of position that the whole jaw has to be surgically repositioned as part of the orthodontic treatment, then public insurance will also pay for such treatment in adults.

Orthodontic Indicator Categories (KIG): The green areas indicate that public health insurance pays and the red areas means that the patient pays

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different rules apply to private health insurance. Here, virtually any kind of treatment for children and adolescents is covered, although this willingness on the part of the insurance companies to pay is slowly dwindling. All of the private insurance companies get their own allocated assessors to check every single adult treatment plan. These assessors usually have long-term contracts and so they obediently classify every orthodontic treatment application submitted as medically unnecessary. This often leads to endless arguments that can only be resolved if the patients are prepared to fight for themselves.

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