I currently have an health insurance with an extra dental insurance in the Netherlands. I had a dental problem and went to a clinic. I sent the invoice to the insurance company but they consider this to be covered by the "general insurance". Result: I have to pay the bill completely because I am still under "my own risk". They refuse to pay this from the dental insurance, which would cover the bill, because they argue this was a specialist treatment. This makes me wonder why do I need a dental insurance then?

Who can I contact to have further information and solve this issue?

closed as off-topic by Mark Mayo, Dirty-flow, SztupY, Andrew Lott, Karlson Mar 17 '14 at 15:08

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You “need” a dental insurance for routine dental treatment by your dentist like a bi-yearly dental check up and simple fillings for cavities. But usually the maximum coverage is only two or three times higher than the premium, which does not make for a very good insurance: Instead of paying a (relatively) low premium for a rare but expensive event (like being hospitalized), most people pay about the same in premiums than they use in dental treatments. And when you need insurance the most (i.e. if you have to get really expensive dental treatment), you are not covered and must shoulder most of the costs yourself.

Dental surgery (were you referred to a specialist within the clinic?) does not require extra insurance and since mandatory health insurance coverage is defined by the law, it's probably not specific to your insurer or mine (the same thing happened to me a few years back). Note that even if you did have to pay more than you expected in this case, the rule is actually to your advantage. You can drop the dental insurance (a bad deal in any case) and still be covered for serious problems like the one you had. Also, if you need some other medical treatment in the same year, you will reach your deductible (eigen risico) quicker.

So it can be a nasty surprise the first time but it's not really an issue that could or should be “solved”, it's just the way it works in the Netherlands.

  • Thank you for your comment. The probability of needing further treatments ia low. I would definitly prefer the dental insurance to pay for this. That's why I have it. True that for some reason I cn have any other health problem, and I will have to pay from "my own" risk, but I prefer this chance than having to pay right now. – nsn Mar 15 '14 at 21:26
  • @nsn Yes, I can understand the surprise and this answer won't help you this time around but that's simply not covered by dental insurance in the Netherlands. Dental surgery is covered by regular health insurance (and therefore comes with a mandatory deductible). If you want to spend 100-300 € a year on this (typical price for dental insurance), you can also pay an insurance with a lower deductible. – Gala Mar 15 '14 at 22:26

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