Dental prostheses: how to be reimbursed?

Dental prostheses: how to be reimbursed?

Do you need to replace one of your teeth or need orthodontic treatment? Did you just get a crown and paid $200 more than your cousin for the same dental treatment? No wonder that.

Dental costs related to the fitting of prostheses or dental implantology are set freely by your dental surgeon. Not to mention the Social Security reimbursements which are very low. A few tips to remedy this and not blow your mutual health budget.

Dental prostheses: low coverage

The conclusion is clear. Social Security reimburses very badly the dental prostheses which appear on its list. Its reimbursement basis (BRSS) is much lower than market prices. For example, a crown costs at least 300 euros. Social Security pays you 70% of 107.50 euros or 75.25 euros. It is thus 224.75 euros that come out of your pocket.

In addition, dental surgeons set their fees as they see fit depending on the acts performed. Thus, the devitalization of a tooth, a scaling, the extraction of a tooth, or the fitting of an implant or a crown will not be invoiced at the same rate. The amount of your dental estimate will vary depending on your geographic area, the health professional consulted or the raw material used to make your prosthesis.

The table below gives you an overview of the prices charged, the level of reimbursement, and the remaining charge (RAC) if you have not taken out a health insurance contract or a mutual insurance company with additional health insurance.

Dental prostheses: advice to reduce your out-of-pocket costs

1st reflex to lower your health expenses: use an online comparator to obtain several quotes from mutual insurance companies.

It will also be necessary to consult and ask different practitioners for a dental quote.

If necessary, you can download an estimate template to give to the practitioners concerned. Make sure it includes the following details:

  • The date of establishment of the estimate and the period of validity are specified.
  • The dentist’s identity and signature are affixed.
  • The processing and materials used for the prostheses are described. The professional must specify the Social Security nomenclature of the act. For example, for an inlay-core, your estimate is marked SPR 57.
  • The practitioner details the number of his fees and the amount reimbursed by Social Security.
  • Finally, he must add this sentence:  The patient acknowledges having had the possibility of choosing his treatment.

This estimate will also be used to request coverage from your mutual insurance company. This prior agreement is mandatory before you seek treatment because it allows you to check with certainty the nature and the reimbursement ceilings associated with the medical procedures that will be carried out by the specialist you have chosen.

Taking out complementary health insurance is therefore a must if you want to benefit from health coverage that allows you to cover your medical expenses, whether dental, optical, or hearing.

Dental prostheses: the coverage of your mutual insurance

Need dentures or implants? All complementary health insurance contributes to your costs. However, some reimbursement methods are more advantageous than others.

Refunds in percentage

Are the prostheses that the dentist offers you reimbursed by Social Security? Most mutuals offer you a percentage of the BRSS. Outside this base is very weak. To be well reimbursed, you will therefore have to take out complementary health insurance that is very covering and therefore rather expensive. The table below gives you the percentages necessary for a moderate load rest.

Mutuals that reimburse more than 350% of the BRSS are rather rare and very expensive. In addition, they are also very covering for other care items: hospitalization, optics, visits to the doctor… You risk paying unnecessarily for guarantees that you do not need. Finally, most formulas limit the amount of their reimbursement by setting an annual treatment ceiling. Solutions exist:

  • Choose a mutual with limits that increase over time. It limits the number of its repayments the first year to increase the following.
  • Opt for complementary health insurance with a care network. The dentists who are part of it practice few excess fees. They also offer prostheses at a reasonable price.
  • Some supplements also offer options to strengthen your dental reimbursements. You can adjust your contract according to your needs.

Refunds in euros

Reimbursements in euros mainly concern prostheses not covered by Social Security. These include, for example, dental implants or gum care: gingivitis, periodontitis, etc.

1st selection criterion: the mutual insurance concerned must reimburse this type of intervention. Indeed, some responsible contracts refuse to cover dental prostheses not covered by Social Security.

Also, look at the ceilings offered by your mutual. The ideal? Choose an amount that increases over time. Often, from the 2nd year of subscription, your loyalty is rewarded. After 2, 3, or 4 years, you can accumulate a sum that covers your costs well.

Refunds in euros and percentage

Some health insurance companies, which are rarer, offer you a reimbursement as a percentage of BRSS and a fixed supplement in euros. This solution is very interesting. You can choose a health supplement with an average percentage. Your package then gives you a boost.

Let’s take an example :

  • Your braces cost 400 euros.
  • With a 300% BRSS mutual fund, you still have 193.50 euros to pay.
  • If you had taken a 200% formula with an additional package of 150 euros, you would only have had to pay 121 euros.

This flat rate is often annual and can also increase over time. Take a good look at these two aspects as well.

By aamritri

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