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The treatment and cost plan for dental prosthetics: checking it correctly

Before larger dental prosthetics are done, the dentist draws up a treatment and cost plan. It must be submitted to the health insurer before the start of treatment, so that the fixed subsidy is approved. The plan is also the basis for comparing costs and alternatives.

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Your chances of getting your money back

For dental prosthetics, the statutory funds pay diagnosis-related fixed subsidies (§ 55 SGB V). The treatment and cost plan must be submitted to the fund before the start of treatment, which checks and approves it.
A well-kept bonus booklet increases the fixed subsidy. With a second opinion and the comparison of standard care and more expensive variants, costs can often be saved.

What you should do now

  1. 1

    1. Have the plan drawn up

    Have the treatment and cost plan with the diagnosis and planned care given to you.

  2. 2

    2. Submit to the fund

    Submit the plan to your health insurer before the start of treatment.

  3. 3

    3. Obtain a second opinion

    For expensive dental prosthetics, obtain a second dental assessment.

  4. 4

    4. Compare variants

    Weigh up standard care and higher-quality care including the own contribution.

How to spot the scam

  • The treatment begins before the fund has approved the plan.
  • Expensive variants are recommended without a comparison with standard care.
  • The bonus booklet is not taken into account.

Frequently asked questions

What is the treatment and cost plan?

A document from the dentist that lists the diagnosis, planned care, and expected costs for dental prosthetics. It is the basis for the fixed subsidy from the health insurer and must be submitted and approved before the start of treatment (§ 55 SGB V).

How high is the fixed subsidy?

The fund pays a diagnosis-related fixed subsidy based on standard care. A gaplessly kept bonus booklet increases it. If you choose more expensive care, you bear the extra amount yourself. A second opinion helps to classify the costs.

Is a second opinion worthwhile?

Often yes, especially for elaborate dental prosthetics. Different dentists propose different care and prices. With a second treatment and cost plan, you can compare and avoid unnecessary costs, without giving up good care.

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General information for self-help, not legal advice (RDG). In case of a high loss or uncertainty: contact a consumer advice center or a lawyer.