Go see the practitioner of your choice!
In Austria, patients insured with one of the statutory health insurances enjoy free choice of a health care professional. That means you also have the choice between a Kassenarzt – a doctor who works “for” a certain insurance company and is bound by the statutory rates and procedure catalogue of that insurance – and an elective practitioner. Not sure about the differences between these two standards of care? Here are some answers to your important questions!
FAQ
What is an elective doctor?
If the doctor you have chosen does not have a contract with your health insurance company, then, for you, he or she will be an elective practitioner. If that is the case, you will need to pay the fee for the treatment out of your own pocket. However, as opposed to seeing a private doctor, where you wouldn’t be entitled to any kind of financial support from your insurance, a large percentage of the cost of treatment by an elective doctor will later be reimbursed by your insurance.
A doctor can well be a Kassenarzt and an elective practitioner – that is, he or she might have a contract with some insurance companies, and no contract with others. The MeinZahn office is a real life example for this duality: We have contracts with the KFA (Krankenfürsorgeanstalt der Magistratischen Abteilungen der Gemeinde Wien)and the SVA (Sozialversicherungsanstalt der Gewerblichen Wirtschaft) – that means, we are Kassenarzt for patients insured with these two providers. For patients with different providers, we are elective practitioners.
That means, patients with KFA and SVA simply “pay” with their insurance card, while our other patients receive a bill for their treatment. By the way: Don’t hesitate to ask for our help with claiming reimbursements from your insurance (see below). It is really no trouble at all! We have deliberately decided in favour of the cooperation with the KFA and SVA: their dental benefit plans are a better match for our high care standards that those of most other insurers, as they cover, for example, professional oral hygiene and implant costs.
Do elective doctors have more time for consultation and treatment?
Yes indeed, they do. Insurers impose a lot of very detailed stipulations on the practitioners they cooperate with. This includes precise regulations for the duration of consultations. As elective practitioners, we are privileged to take exactly the time we need for anamnesis – getting to know our patients – and consultation.
This is in accordance with our ideals and ideas of medicine with a human face. We collect all the information we require – listening to our patients, asking questions and following up. We provide you with comprehensive information and consultation, making sure you have all the facts at your disposal to make an informed decision for the therapeutic option that best meets your various individual needs.
Can a Kassenarzt offer all therapies and medication of his/her choice?
No, they can’t. Insurers have their very own – and, honestly, not always entirely comprehensible – views about what services to cover or not to cover. No doubt, the necessity of cutting down on costs plays an important part in many negative decisions. Having read up on or talked to friends and aquaintances about possible treatment options, patients who see their doctors with particular ideas and expectations are often disappointed when told their Kassenarzt doesn’t even offer the therapies they had set their hopes on.
As elective practitioners, we at MeinZahn are entirely free in our choice of what treatments and medications to offer to our patients. Our broad spectrum of modern, state-of-the-art dental services includes many attractive options we are convinced our patients will benefit from.
But surely, patients must expect high supplementary payments with an elective doctor?
No. You will need to make a supplementary payment, that is true. But it doesn’t have to be high at all. For elective practitioner services, insurers reimburse 80 percent of what they would pay a Kassenarzt for the same service. Since your elective practitioner is interested in your satisfaction, he or she will creatively use their right to set their own fees to make sure the difference between fee and reimbursement will be as small as possible. That means elective doctors sometimes even bill smaller fees than what a doctor with an insurance company contract would receive for a comparable treatment.
So, yes, it is true that you will have to supplement a certain amount. But your elective doctor will always strive to keep the scope of supplementary payment acceptable for you. Most patients don’t mind the small financial burden – as it comes with a big surplus of consultation and treatment quality.
Is it complicated to claim reimbursement from the insurance companies?
Not really. However, somebody who doesn’t do that on a daily basis might feel overwhelmed by the paperwork. This is why we offer our patients the additional service to take all the reimbursement formalities off your hands. We submit all necessary documents to your insurer and deal with the entire correspondence. This way you can rest assured everything is well taken care of, all due dates are kept and your claims are asserted with optimum success.
In conclusion: With an elective doctor, you practically enjoy the status of a private patient when it comes to services and treatment – but without the burden of high fees. Comprehensive consultation and state-of-the-art dental medicine are not to be had at zero cost in Austria, unfortunately. However, insurance reimbursements for elective practitioner services actually make it possible for (almost) everyone to afford that kind of dentistry – with an elective doctor of their choice!
„Ich gehe zum Arzt meiner Wahl!“
Wahlarzt: Das Beste aus beiden Welten
Patienten auf Arztsuche treffen in Österreich auf Kassenärzte, Wahlärzte und Privatärzte.
Wer bei den öffentlichen Kassen und Sozialversicherungsanstalten versichert ist,
hat die Wahl. Kassenarzt oder Wahlarzt – wo liegen die wichtigen Unterschiede?
Wahlärzte haben mehr Zeit für Beratung und Behandlung
Auf jeden Fall! Durch den Wegfall der von den Kassen gemachten formalen Vorgaben einer Konsultation4 kann der Wahlarzt ganz im Sinne einer humanistischen Medizin nach eigenem Ermessen entscheiden, wie viel Zeit für Beratung, Aufklärung und Behandlungen benötigt wird.
Unser Leitsatz: Nur die richtige Information ermöglicht die richtige Therapieentscheidung. Das setzt voraus, dass wir Zeit für eine ausführliche Anamnese und eine ausführliche Beratung haben. Wir hören Ihnen zu, untersuchen Sie und erläutern Ihnen daraufhin Ihre Optionen umfassend.
Kassenärzte dürfen nur bestimmte Therapien und Medikamente anbieten
Wahr. Die Kassen erlegen ihren Ärzten vertraglich nicht nur viele formale, sondern auch inhaltliche Zwänge auf. Gerade Patienten, die bereits in eigener Sache informiert zum Arzt gehen, sind oft enttäuscht, dass ein Kassenarzt die erhofften Leistungen nicht im Programm hat. Als Wahlärzte sind die Zahnmediziner bei MeinZahn frei in der Therapiewahl. Daher können wir Ihnen ein zeitgemäßes, breites Leistungsspektrum der modernen Zahnheilkunde anbieten.
Bei einem Wahlarzt muss man immer mit erheblichen Zuzahlungen rechnen
Falsch. Wahlärzte können Ihre Honorare frei gestalten. Das bedeutet nicht automatisch, dass ihre Stunden- und Leistungssätze besonders hoch sind. Im Gegenteil. Für Wahlarztrechnungen erstatten die Kassen 80 Prozent der jeweiligen Kassensätze. Ihre Zufriedenheit liegt Ihrem Wahlarzt am Herzen, daher ist es auch in seinem Interesse, dass die Differenz zwischen Rechnungsbetrag und Erstattungsbetrag möglichst klein ist und Sie als Patient wenig zuzahlen müssen. So stellen Wahlärzte für die gleichen Leistungen häufig sogar niedrigere Rechnungen aus als Ärzte mit Kassenvertrag.
Wahr ist, dass Sie etwas zuzahlen müssen. Aber Ihr Wahlarzt wird sich immer darum bemühen, diese Zuzahlung in einem für Sie akzeptablen Rahmen zu halten. Und den meisten Patienten sind die hervorragende Beratung und Behandlung, die sie bei einem Wahlarzt erhalten, diese finanzielle Zusatzbelastung wert.