What do I pay at a private dentist, and what do I get back?

What is the difference between a contracted dentist and a private dentist?

Contracted dentists (Vertragszahnärzte, often called Kassenzahnärzte) have a contract with the health insurance fund. For covered treatments, your e-card is all you need there. ÖGK pays the full tariff rate for these treatments.

Private dentists (Wahlzahnärzte) have no such contract. They set their own fees, which can differ considerably from the tariff rate. You pay the invoice yourself first and then get part of it back from your fund.

You are free to choose whether you see a contracted dentist, a private dentist or go to an ÖGK dental health centre.

How much will ÖGK reimburse?

ÖGK reimburses 80 percent of the amount it would have paid a contracted dentist for the same treatment. It never reimburses more than you actually paid.

So what counts is the tariff rate, not the amount on your invoice. Since private fees are usually higher, ÖGK says that in practice people rarely get 80 percent of their costs back.

For tooth replacements (Zahnersatz), ÖGK first deducts the co-payment from the tariff rate and then reimburses 80 percent of the rest. The treatment and cost plan (Heil- und Kostenplan) must be approved by ÖGK in advance.

So ask about the costs before your treatment.

How do you submit your invoice to ÖGK?

First you pay the invoice at the practice. There are then two ways to submit it:

• The private practice submits the invoice electronically for you via the WAHonline system. This is optional for dentists, and you need to give the practice your bank details.
• You submit the invoice yourself, using the „Rechnung einreichen“ (submit invoice) service on the ÖGK website or in the Meine ÖGK app.

ÖGK needs the paid invoice showing the treatment details and diagnosis, along with your name, date of birth and social insurance number. You also need the practice stamp and proof of payment.

You have 42 months from the date of treatment to submit it.

What does the fund pay for, and what do you pay yourself?

Treatments covered by ÖGK include, for example:

• composite (tooth-coloured) fillings in front teeth and canines
• root canal treatment
• removal of tartar by the dentist
• surgical procedures
• removal of teeth and tooth roots

You pay for special requests yourself. Anaesthetic injections for fillings are usually not covered, with exceptions for children, for example.

According to ÖGK, fixed tooth replacements such as crowns, bridges and implants are generally private treatments. A contribution is only paid for special medical reasons. ÖGK contributes to removable dentures if they have been approved in advance.

ÖGK does not reimburse purely cosmetic treatments.

How does it work with SVS, BVAEB and KFA?

With SVS and BVAEB, you also pay for private treatment first and then submit the paid invoice. Both funds reimburse part of the costs. Your fund can tell you how much.

With SVS, you can take a photo of the invoice in the svsGO app or upload it to the svsGO customer portal. Since 1 July 2024, private doctors can also submit the claim for you if you wish.

At our practice, we bill SVS and KFA directly. For all other funds, such as ÖGK, we treat you as a private dentist.

How does billing work at our practice?

For all funds except SVS and KFA, the process is as follows:

1. Bring your e-card to every appointment.
2. You receive a cost estimate before any treatment.
3. You pay at the practice in cash, by card or by bank transfer. Instalments are also possible for larger treatments.
4. You receive an invoice and submit it to your fund. We are happy to help you with this.
5. Your fund reimburses part of the costs.

You can discuss costs and reimbursement with us in German, Georgian, Russian, Polish, Turkish or English.