– Why are some services compensated and others not?
– Certain requirements and conditions are set for the provision of services, which are defined in the laws that regulate the provision of dental services.
– What are the services and how are they compensated?
– The main condition for the services to be reimbursed to the patient is that the patient is covered by compulsory health insurance. The services must be provided in a medical facility that has a contract with the Health Insurance Fund. For primary care services, the patient should go to the facility they are registered with, and for specialist services, the patient should go to a specialist dentist with a referral.
Primary dentistry services include treatment of dental caries, treatment of pulpitis, extraction of teeth and tooth roots, cleaning of tartar, and in case of trauma, placement of temporary braces. It is important to note that primary care services do not require a patient referral. He simply registers at his treatment facility and receives consultation and services.
If the dentist determines that this is a very complicated case and requires the help of a specialist, in such a case he sends the patient to a specialist doctor, making a referral. With such a referral, the patient can apply to both a public and a private treatment facility, it is only important that that facility has a contract with the Health Insurance Fund.
I also want to note that the shipping is valid for 180 days. Therefore, during this period, the patient must register for a consultation with the appropriate doctor.
It happens that the patient needs to pay for some of the measures. The health fund only pays for the doctor’s work. Patients pay for dental materials, medicines, disposables and other consumables themselves.
There are certain groups of patients who should not pay anything for the services they receive: these are children, students of day schools and professional full-time studies under the age of 24, and socially supported persons who present a certificate from the social support center. So they don’t need to pay for additional measures, unless the child wants, say, a colored seal.
– Does the patient need to fill out any documents for reimbursed services?
– The patient himself does not need to fill out documents. Shipments are also issued in electronic form, so there is no need to have them physically either.
– What other services are compensated?
– It is also important to mention that prevention of children’s teeth is compensated from the budget of the PSDF fund: covering children’s molars with sealants, as well as oral hygiene for young people from 13 to 18 years old can be performed at the polyclinic, children up to 13 years old can have tartar removed as many times as the doctor thinks it is necessary. Dental prosthetic services are also paid for. These services are not reimbursed for all patients, but only for certain groups: children under 18 years of age, elderly persons, unemployed or partially employed persons. Services after oncological diseases are also reimbursed.
You will also find out in the show “Odontologists give advice” if there are exceptions when you also need to pay for compensated services:
