- Dental treatment according to compulsory medical insurance
- Money
- Quality
- Compulsory medical insurance in private clinics
- Dental treatment according to VHI
- Money
- Quality
- Compulsory medical insurance or VHI
When treating teeth, everyone can go in three ways: trust paid medicine and the capabilities of your wallet; go to public dentistry and get all the services relatively free of charge or trust the VHI (supplementary health insurance) that your employer can offer you. With paid treatment, everything is clear - any whim for your money. But what to choose when there is a choice: compulsory medical insurance or voluntary medical insurance? What is better and more profitable? Is it worth paying an extra ten thousand for additional health insurance and buying a policy yourself? We are discussing these issues with dentist Maria Matievskaya, who works as a dispatcher in the insurance system.
What do you need to register with a dental clinic and how to make an appointment?
To register, the patient must go to the selected clinic with a compulsory medical insurance policy, a passport and a written application. At the registry, the data will be entered into the database and the services will become available.
Appointments can be made in advance through a personal call to the PC, through a terminal in the lobby or through an online application. The patient receives a coupon with which he goes to see a doctor.
Without a coupon they are accepted only in acute situations when it comes to emergency care.
The compulsory medical insurance policy is also valid in some private clinics. The list is also on the insurance company’s website, but there are usually not many of them. Since insurance is not able to cover clinic costs for treatment, free services are provided by a few private dentists.
Dental treatment according to compulsory medical insurance
Money
Compulsory health insurance (CHI) is a system familiar to everyone since childhood, which allows anyone to receive free medical care in Russia.
But “free” here is very conditional. Every worker monthly gives the state 5.1% of his salary to the federal compulsory health insurance fund, which then distributes it. And through insurance companies, the money goes to medical organizations, compensating the costs of your treatment and the salaries of doctors in public clinics.
Due to the fact that every month you pay part of your salary, at the moment when you need to improve your health, with compulsory medical insurance you don’t have to think about money - you have already financed your treatment in advance. Or someone did it for you if you are not working. The illusion of freeness comes from the fact that you do not see this money, as well as your own pension contributions and income tax paid - the employer does this for you, but not from his own money, but from your money.
Quality
Under compulsory medical insurance, you can receive almost all dental services except prosthetics, implants, installation of mouth guards and braces.
Treatment of caries, pulpitis, cleaning, filling are also included in compulsory medical insurance. But there is a significant drawback to this treatment - reliable light fillings are not installed for free. You will have to pay extra for them and for high-quality pain relief. The good news is that, as a rule, municipal clinics in big cities always have them in stock.
There can be no good fillings according to compulsory medical insurance. We had chemical-curing fillings installed under the compulsory medical insurance program. This is the last century. Even if they paid me, I wouldn’t put such a filling on myself
According to expert Maria Matievskaya, it is possible to receive high-quality treatment under compulsory medical insurance, but you still need to prepare for certain financial investments. For example, go to treat caries for free, but agree with a doctor to install a high-quality light filling for an additional fee.
You can come under the compulsory medical insurance program and say directly: “I want to get a good filling, good treatment. What does that require?" You don't have to get treatment right away, but you can listen and find out what options the doctor suggests. First of all, I would recommend consulting and then making a decision
In addition, the compulsory health insurance system includes teeth brushing to a limited extent. You can count on tartar being removed from your teeth without affecting the spaces between your teeth. Often clinics simply do not have such technology. As for surgical dentistry, it makes sense to contact public clinics under the compulsory medical insurance program. This is due to the fact that doctors in private medical institutions that accept voluntary health insurance work part-time in several branches of dentistry. It turns out that if you need to see a specialist, it will be easier to find one in a state clinic, where there are more staff members and “generalists” are less common.
Compulsory medical insurance in private clinics
Yes, some private hospitals and clinics receive funding from the compulsory medical insurance fund, which means you can be treated there for free. You can find out which private medical center you can go to with your compulsory medical insurance policy on the website or by calling your regional compulsory insurance fund. Here are the sites of Moscow and St. Petersburg.
To contact a private clinic, you will need a compulsory medical insurance policy, a passport and SNILS. But be prepared to wait - there may be separate reception hours, separate queues, and a very limited list of services for you.
When does it make sense to go to a private clinic under compulsory medical insurance? For example, when tests, high-tech research (MRI, CT) or an operation covered by compulsory medical insurance are urgently needed.
You can also get dental care, but here you need to clarify in advance what kind of manipulations the private clinic is ready to perform with you.
How to make an appointment at a private clinic:
Even if a private clinic is included in the insurance company’s list, you should check with the clinic directly about the possibility of treatment under compulsory medical insurance. Do not forget that the patient may still pay for some procedures. It is better to ask these nuances before starting treatment to avoid misunderstandings.
If the clinic really provides compulsory medical insurance services, the patient must go to the clinic at his place of registration and get a referral from a doctor.
When all the details have been resolved, you can make an appointment.
IMPORTANT!
Contact your insurance company with any confusion or questions. This can be done by calling the hotline or during a personal visit.
Dental treatment according to VHI
Money
Voluntary health insurance (VHI) is a policy that gives the owner the right to receive medical services in private clinics, provided that the person has chosen the desired tariff from the insurance company and paid for it in advance. Of course, the most common way to get such a policy is as an additional bonus from your employer. In this case, the employer pays your contributions to both the compulsory medical insurance fund and the insurance company for VHI, and it already covers the costs of private clinics for your treatment. Each insurance company works with its own list of medical institutions, so you need to immediately clarify it by purchasing a policy yourself or receiving it at work. A voluntary health insurance policy can be basic or extended. For example, not all VHI policies include dental services, but they can be purchased in addition. The range of tariffs here is very large and depends on the insurance company. When a person with VHI has a toothache, he does not immediately go to the clinic. The first thing he does is call the insurance company and describe the symptoms to the doctor on duty. Based on the complaints, the dispatcher draws up an approximate picture of the disease and chooses which specialist to refer the patient to. If there are no special restrictions, the dispatcher takes into account your wishes - closer to home, closer to work, and so on. In order to receive further treatment under insurance after the initial appointment, you need to be given the correct diagnosis, and the doctor and the clinic have a financial interest in further caring for the patient. However, there is a nuance with VHI - sometimes the doctor is interested in selling services under VHI, and sometimes - private services of the clinic. The fact is that there are several types of insurance. The first type, attachment, involves a one-time visit, often with acute pain. They will not leave you to suffer, they will help you, but if the problem requires long-term treatment, insurance will not cover it. The second type of insurance is factual. In this type of insurance, treatment is agreed upon in advance with the clinic and the insurance company.
Naturally, it is more interesting to accept such patients, from whom we receive money every time
The attachment amounts, based on the VHI tariff, vary. On average, the clinic will receive from 800 rubles to 5 thousand rubles for a one-time patient.
Let’s say, according to the clinic’s price list, treating caries on average costs around 5 thousand rubles. And a patient, for example, has a thousand allocated for treatment under VHI. What interest do I have in treating his caries? Accordingly, I can lie to the patient, say, “You don’t just have caries here, you have caries with a large degree of tooth destruction and this is not an insured event, but you can treat it for a fee, I can even give you a discount since you came under the insurance program.” to still retain the patient
When coming for dental treatment under VHI, the patient cannot know for sure whether he will be treated completely free of charge, whether insurance will partially cover the treatment, or whether the doctor will try to impose additional services. It's always a gamble. And the insurance company can't verify who is right—they have to trust the doctor who examines you. Because the doctor is close to you, but the insurance manager is far away.
Quality
The patient may feel that VHI provides better quality treatment than compulsory medical insurance, since the employer or you personally contributed additional money to obtain insurance for yourself. It's a convenient idea, but it's often not true.
The VHI system does not bring much money to doctors, but it does bring money to clinic owners. Clinic owners do not want to invest in treatment under VHI and often purchase the cheapest materials for treatment through insurance.
According to Maria, it often turns out that in the same clinic, fillings that are provided for paid treatment are of better quality than fillings for those treated under VHI. It all depends on the greed of the particular owner of the clinic.
At one of my places of work, we had the same material for filling canals both for compulsory medical insurance and for payers. No expense was spared on materials. And at the same time, that material was of higher quality than when I worked in another private clinic and was treated under VHI and for a fee.
Some services, like taking pictures or brushing your teeth, can be safely done under VHI, because few consumables are needed, and it’s difficult for a specialist to save money on you and ruin something. In other cases, for quality treatment you need to be willing to pay extra.
If you want to receive high-quality treatment under the VHI system, you should prepare for financial investments, since insurance will not be able to cover the entire cost of the doctors’ work and materials. Moreover, it is better to immediately indicate your position to the doctor: say that you are interested in the best result and are ready to pay extra for this. This will make things easier for everyone.
Consumables and drugs under compulsory medical insurance
Insurance companies only pay local manufacturers. Therefore, imported consumables and medicines are not included in the program.
What you can count on:
Composite material
Some domestic medicines
Material for dressings
Consumables for equipment
Anesthesia drugs
In general, this is not a small list that allows you to qualitatively cure a tooth or an oral disease.
In some cases, the doctor may suggest an alternative imported material, but it will be added to the invoice for payment.
. You can refuse the offer; the decision is up to the patient.
Light seals
Dental cement is one of the very first materials in dentistry. Over the entire period of use, it has proven itself well, despite its short service life. But in modern dentistry, better alternatives have appeared - light fillings.
They are also included in the insurance program and can be installed free of charge, but only if indicated. In free dentistry, such fillings are most often placed on the front teeth.
Compulsory medical insurance or VHI
If voluntary health insurance is not offered by your employer, then applying for it yourself does not make much sense. In this situation, it is more profitable to be treated under compulsory medical insurance, choosing clinics based on reviews on the Internet or word of mouth. In order to be treated by a doctor you like in a public clinic, you need to detach yourself from the one to whom you are assigned at your place of residence.
Many are treated in government clinics and are friends with doctors. You come and the doctor performs some manipulations on you under the compulsory medical insurance policy, but at the same time you receive high-quality treatment. Roughly speaking, a filling costs 3 thousand. You pay 1–1.5 thousand into his pocket, and the rest goes according to the policy. And it will be more profitable than going under the VHI program
VHI, if it is paid for by the employer, is beneficial to use for preventive examinations, research, tests, to get general advice, to do high-quality teeth cleaning, which is provided in a greatly reduced version under compulsory medical insurance.
Both under compulsory medical insurance and under VHI, you need to be prepared to pay extra and directly ask the doctor what he would recommend for better treatment.
Also, if you have a VHI policy, you need to know what services are included in your specific insurance so that the doctor does not deceive you. For example, he may say that your tariff does not include consultations, although this is not true. In addition, it is better to choose a clinic and a doctor that have proven themselves well in advance, based on reviews and recommendations. In this case, if the doctor tells you that the materials for treatment are not of very high quality, you will have more reason to trust his words.
Compulsory medical insurance policy
Every citizen of Russia has the right to take out a compulsory health insurance policy - compulsory medical insurance. It applies to everyone - from infants to pensioners, no matter whether you are working or unemployed.
A policy is a guarantee from the state that it will pay for the medical services you are entitled to. That is, not those that you would like to receive, but those on which your health directly depends . For example, under the policy, your caries will be treated or a bad tooth will be removed, but your bite will not be corrected, or implants or veneers will be installed. This, according to the state, is already excessive.
