About the medical necessity of ceramic dental implants

Private health insurance often only recognises technical innovations when they have been academically recognised and have established themselves on the market. Scientific publications can support the medical necessity of a particular treatment approach; yet the mere absence of a publication to date cannot be used to support the rejection of medical necessity (Regional Court Tübingen, Judgem. date 11.05.05, 3 O 267/03, p. 7 top).

The overly restrictive approach of private health insurers has become apparent again and again:

According to an assessment of the Federal Social Court, implant-supported artificial teeth have been scientifically proven since "the end of the 1990s“ (BSG, Judgem. 19.06.01, B 1 KR 23/00). Dental implants achieved breakthrough in terms of private health insurance reimbursement from 2003, when the civil courts clarified that comparisons in terms of cost with conventional removable treatments was not permissible and that even comprehensive implant treatments could not be regarded as so-called luxury treatments (BGH, Judgem. dated 14.03. 03, IV ZR 278/01). Subsequently, so-called dental disk implants were recognised as conventional care (Regional Court Köln, Judgem. dated 29.03.06, 23 O 269/03). The medical necessity of the approach of immediate loading of dental implants has been confirmed at least since 2007 (Regional Court Köln, Judgem. dated 07.02.07, 23 O 458/04, NJW-RR 07, 1401).

As we will presently see, private health insurers also set the bar too high with respect to the scientific recognition of ceramic dental implants and wrongly refused reimbursement:

Recently, treatment plans and treatment using so-called ceramic implants made from zirconium oxide in regions 15, 16, 23, 24, 25 has been deemed to be medically necessary in the sense of § 1 Para. 2 MB/KK and the insurance has been ordered to make standard reimbursement available (Regional Court Köln, Judgem. dated 08.06.2011, 23 O 274/09). This was in the case of a 60 year old male patient, who was found to be titanium intolerant and who had opted for ceramic implants for this reason. In the lower jaw, which had already been treated with ceramic implants, a zirconium implant in region 47 was replaced. The court also deemed that the costs for general anaesthetic were reimbursable in view of the magnitude of the procedure.