Zahnzusatzversicherung zahlt nicht trotz erster zusage? Was tun?
Folgendes:
Anfang Juni wurde nach kostenvoranschlag erstmal eine Deckungszusage gegeben für die Kostenübernahme der Implantate.
Vor paar Wochen wurde dann ein Auskunftsersuchen vom vorherigen Zahnarzt angefragt.
Jetzt schreibt die Zusatzversicherung:
Behandlungsbedürftigkeit laut Auskunftsersuchen des Vorbehandlers vor Versicherungsbeginn bekannt
Leider können wir Ihnen keine Erstattung zusagen, da die behandelten Zähne laut Auskunftsersuchen Ihres Vorbehandlers bereits vor Versicherungsbeginn behandlungsbedürftig sind / waren.
—In diesem Auskunftsersuchen steht aber vom Zahnarzt drin unter 3) Keine weitere Therapiemaßnahmen angeraten.
Sonst steht da nichts von “notwendiger behandlung” oder irgendwas in der Art
Das heißt doch im enddefekt, das keine weitere behandlung angeraten wurde und somit keine direkte Behandlungsbedürftig bestand?
Wie soll ich da jetzt weiter verfahren?
(2 votes)
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Turn on the insurance company.
Address and telephone number can be easily ergooglet for your local area.
This is free and often successful.
in principle, you need to know that insurance – some at least – come out to hell to find everything possible to not have to pay.
You need to read in your contract insurance contract again how this is meant with “from when and under what conditions” insurance start also runs.
It was clear with me that there were also some damages already and the dentist (which I did not change) simply wrote that my bridge no longer holds and implant is now advised.
I didn’t have a pewter.
I’m not a lawyer right now, but for other reasons, I’ve always had to fight with my parents’ health insurance. They do everything right when you fight, funny, right???
You have to hold these arguments again in writing, and this includes (1) the copy of the first undertaking) (2) the letter of the pre-handler, from which – as you write – it is clear that this was NOT a pre-crisis. That’s what you’ve done. Just sending the letter doesn’t matter.
Maybe they’re apologising with a thready argument. But if you don’t, you’ll actually have to take a lawyer. But can also be the references to something, WAS I DO NOT WEISS.
But officially make an oath, you’re making it timely.
If you can afford this, you’ll be happy to have a lawyer. But I don’t see a problem doing it on my own. But really writing in writing. No fax!
If they are completely stubborn, then nothing else will be left to you to quit. No one needs such insurance.
Hello. I write here again because it was so nice and detailed. Once gave it to my lawyer, the following came:
Thank you very much for your request, which I will be able to answer as part of the initial consultation on the basis of its facts.
According to paragraph 2 para. 3 of the insurance conditions begins the insurance case which, according to point 2(7). 2 of the insurance conditions is a medically necessary dental treatment, with the treatment and ends if there is no need for treatment after a dental finding.
The pre-handler has confirmed that there is no need for treatment anymore. We therefore believe that there is a (new) insurance case.
Share the reasoning and that it is a dental treatment necessary is your insurance and ask for the cost and feedback within 14 days.
So the impression was also confirmed after insight into the documents
perfect. Take the main part of it and design your letter. Don’t let it hang out that you were with the lawyer. But these figures, etc., and the exact wording 1:1.
In all other cases, if anything goes by phone, always let contact persons and note telephone time/date. Be aware that telephone information is never legal basis. In case of promises, confirm in writing.
Most people have no idea how important it is. Luckily, I’ve known one of the others before – you can ask everyone who organizes private papers or when it comes to a cure. 80 percent rejection, and only after-carrying is paid.
And there’s method behind it. You can imagine that many are either missing the time, or even simply the verbal possibility of expression, and therefore I certainly do not just mean foreigners.
On top it is very complicated. I’ve been really looking. With me, they couldn’t drive any more sleds.
Thanks for the tips with the phone.
The care is really sad, but I’ve actually heard of many people who are almost exploited by the ignorance of the people and are hoping here and there that nobody asks. Too bad, but when it comes to money, there is no more
Clear breach of information, they’re fine.
Even request a file inspection and, if necessary, contest, because it does not apply what the dentist may now say orally to a drilling specialist of the insurance company, but only what is stored in the patient file, which is ineffectively invariable.
I already had many, many years with an extremeAbrasion bite(Knirschen + Zahnmeltschaden) had to do so and it has long since followed a large construction site.
With a view to this – and according to the document in the knowledge that my dentist had already been discussing the problem verbally with me forever, but probably from convenience, had never filed a document for the “fixing and guessing of a treatment” – I completed a ZZV for 75% of the cost of a few € a month ago about 5 years ago.
Exactly after 4 years and a week (…from 4 years onwards, the ZZV in my case is fully engaged.) I am the subject of the first preparatory investigations, creation of salvation and cost plan, etc. for overcrowding in ceramics of all 28 teeth.
For a long time, the new little bites came in in A1 white little later and in total ~28,000€. The ZZV has taken over its share of just over €600 after incoming file checks, despite contributions paid over the duration of the policy. A share of ~7000€ was taken over by the KV and about 7k€ remained to me for the payment of which I got from the state again after tax enforcement as an exceptional burden.
So in total almost 5k€ even for the 28k€ of the completely new dining room accustomed and for this just well paid 600€ ZZV contributions – I don’t want to complain 😉 .