In 2020, virtually half (52%) of dental prosthesis requested by dental surgeons have been a part of the basket 100% well being. This reform, which entered into drive in January 2020, supplies for the full protection of sure prostheses – crowns and bridges. Since 1er January 2021, this basket was supplemented by different prostheses (detachable dentures, and many others.).
The client protection affiliation UFC-Que Choisir has launched a name for testimonials with a purpose to know the doable difficulties encountered by patients.
Following the suggestions, it warns of the complexity of a reform that appears easy on paper. And for good purpose, on the one hand, not all therapies are eligible and, on the different hand, dentists aren’t obliged to supply 100% well being care.
100% Health: quotes which might be tough to learn
With the institution of 100% well being, dental surgeons should present the affected person with a quote standard with info on therapeutic options in 100% Health.
According to testimonies, the explanatory info contained in the estimate will not be at all times very clear; actually, some insured individuals settle for care, believing that they may profit from full protection and typically discover themselves with a big remaining cost, as much as ” several hundred euros “. ” My quote for a transient resin prosthesis is a part of the 100% Health basket. But the estimate of my mutual leaves me with a the rest of € 338 out of € 500 », Thus signifies a affected person.
In element, the estimate consists of two elements. The first signifies the supply proposed by the healthcare skilled. Using a code, he should specify to which “basket” the prosthesis belongs:
- “1” for the 100% Health basket: no out-of-pocket bills apply;
- “2” for the basket at the managed value: stays at reasonable price because of the managed costs;
- “3” for the basket at the free value: stays chargeable typically very excessive because of the absence of value caps.
The second a part of the estimate, known as ” different therapeutic info ”, have to be accomplished in the occasion that the dentist affords remedy together with out-of-pocket bills. He should then point out an equal supply that falls beneath the 100% Health basket, if one exists. Otherwise, he should register a suggestion with a reasonable the rest of the cost.
The reluctance of some dentists to supply 100% Health affords
Another level principally reported, many dentists would refuse to use 100% Health. Patients have been confronted with the following difficulties:
- the practitioner solely signifies on the estimate the therapies he intends to hold out and these induce an excellent cost. This constitutes an error since since the 1erJanuary 2020, the presentation of the standardized estimate is necessary. He should at all times point out the existence of any choices in the 100% Health basket even when he doesn’t carry them out inside his observe (info that he should point out elsewhere). Indeed, practitioners are beneath no obligation to supply prostheses which might be a part of the 100% Health supply. If mandatory, they need to refer the affected person to a colleague proposing it, which might not appear systematic;
- According to testimonies, some professionals are appearing in unhealthy religion, claiming to their patients that they don’t have a provider manufacturing the prostheses in the 100% Health basket. However, nothing prevents them from in search of it. Still others brazenly denigrate these supposedly decrease high quality prostheses.