What are the consequences of the KIG’s for the assumption of costs by the health insurance? | Orthodontic indication groups

What are the consequences of the KIG’s for the assumption of costs by the health insurance?

By means of the orthodontic indication groups, the health insurance company has precisely defined which malocclusions are covered starting from how many millimeters of deviation and which are paid privately. In the case of the statutory health insurance funds, the regulations apply that the orthodontic groups three to five are paid until the age of 17, while groups one and two are not. In the case of private supplementary insurance and private insurance, it depends on the conditions of the insurance to what extent costs are covered, but it is true that private insurance companies usually subsidize and cover more than the statutory health insurance. The insured should first discuss with health insurance company and the orthodontic expert opinion, so that the question of costs is completely settled.

What if the KIG was misjudged by the orthodontist?

Due to the legal regulation of the orthodontic indication groups, there are special guidelines that must be followed in order to produce a correct assessment. Minor deviations result in errors in the orthodontic assessment, which can lead to incorrect classification and the associated recourse. Only a certain probe is accepted for the measurement, the use of another one can falsify the measured values and thus possibly reach a too high or low degree of severity, resulting in an incorrect orthodontic indication group. Careful verification of the expert opinions by the documentation models can lead to subsequently paid funds being reclaimed from the insurance company, so that the patient himself has to pay a larger share.