Dental care: how to get reimbursed?
Dental care today has become very expensive. To help patients benefit from adapted care, the Health Insurance, and mutual insurance companies partially or fully cover consultations, dental care, prostheses, and orthodontics.
Le remboursement de la consultation
Throughout our lives, we are led to consulting a surgeon. Consultations and care are covered by Health Insurance which reimburses patients on the basis of 70% of the conventional rate. This is 23 € for a dental surgeon and 28 € for a dental doctor. Conventional rates are those applied by sector 1 specialists. It is important to know that the amount to be paid to the dentist is the amount of the consultation plus any treatment performed.
Fee overruns and reimbursements for dental care and dentures
Dentists and sector 2 stomatologists apply free fees. It is therefore not uncommon for patients to pay extra fees since the reimbursement provided by the Health Insurance is identical to that of sector 1.
Patients who have subscribed to a mutual insurance company can benefit from an additional reimbursement, the amount of which depends on the guarantees chosen.
The flat-rate contribution of €1, which is normally withheld for each consultation or examination performed, does not apply to consultations and care performed by a dental surgeon.
Reimbursement of dental
A fee schedule specifies the different treatments and the associated conventional fee. These treatments include scaling, treatment of cavities, tooth devitalization, and tooth extraction. It should be noted that two types of fees exist. The first concerns people over 13 years of age and the second concerns people under 13 years of age. The latter is higher. Finally, the sealing of the grooves, special care performed on children under 14 years of age, is covered at 70% of the conventional rate but only once per tooth.
Reimbursement of dental prostheses
Dentures are also reimbursed based on 70% of the conventional fee. These include crowns, inlays, bridges, and dentures. Dentures, on the other hand, are free of charge. Fees vary greatly from one dentist to another. It is therefore imperative to have estimates made and to inquire with your complementary health insurance to know the exact amount of the coverage.
Dental surgeons are required by the Health Insurance to set fees "with tact and measure". Under no circumstances can the specialist force a patient to accept a prosthesis. A signed estimate is imperative to begin this care.
Estimates must include a precise description of the treatment, the amount of the prosthesis, the fees related to the treatment, and the amount reimbursed by Medicare. Please note that a dentist can in no way take into account the coverage of the Assurance Maladie and the complementary health insurance to set his fees.
Reimbursements for orthodontic care
Orthodontics is a special case. To be covered the treatment must be accepted by the Health Insurance via a prior agreement. Treatment must begin before the patient's 16th birthday. The request for prior agreement is filled out by the dental surgeon or stomatologist. If accepted, the orthodontic treatment is covered based on 100% of the conventional fee as well as the first year of support. Monitoring sessions are covered at 70% of the conventional rate. The same is true for the second year of contention.
Orthodontists' fees are free. Overruns of fees are not uncommon. It is essential to obtain an estimate before beginning treatment.
Good management of dental care and dentures
To ensure optimal care, it is advisable to give preference to sector 1 specialists or to find out about the reimbursements provided by the mutual insurance company before starting treatment. Whenever possible, it is necessary to ask for quotes. Consulting several dentists is sometimes important. All consultations are covered. It is also a good idea to be well-covered thanks to adapted complementary health guarantees. Do not hesitate to choose a good mutual insurance company if you are thinking of calling on a dental surgeon.
Dental care is expensive and too many French people give up on dental care due to lack of financial means. However, thanks to a good knowledge of the fees and reimbursements, it is possible to benefit from care adapted to your needs.
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