Zahnreinigung and GKK

[Alberto]

Do GKK pay for Zahnreinigung?
I've always believed no, but maybe I'm wrong.

I have a (private, top-up) Zahnreinigung insurance and they apparently pay every Zahnreinigung. So today I filled my first claim (thanks ChatGPT for the letter). Got an automatic response instructing me too attach Rechnung and proof of payment (both attached already), as well as the rejection from the GKK. This Last was a big surprise.
For the record, my GKK is TK.

Thanks a lot

[Kerfuffle]

TK pays 40 EUR towards Prophylaxe only.

[Alberto]

TK pays 40 EUR towards Prophylaxe only.

Thanks.

[Alberto]

TK pays 40 EUR towards Prophylaxe only.

Thanks.

I am a little annoyed by the way they replied because this way I am forced to write one more letter, to my GKK TK now, asking a refund, knowing already they won't cover it. And they may or may not reply. Yeah, whatever, there is worse in life...

Beside, this is what I don't get:
my dentist recommends TWO Zahnreinigung a year, so tot cost. ca 240eur/yr, or 20eur/month. This insurance I have apparently covers EVERY Zahnreiningung and it costs 16eur/months. Where is the catch?????????????

[pappnase]

I suspect €120 per cleaning is what your dentist would charge you if you pay directly, but that the insurance pays somewhat less.
I also suspect that like all insurance policies they rely on the fact that many people will buy the insurance but never claim, and so averaged over all their customers it works out.
If they couldn't make a profit on the insurance, then they would have gone bust by now.

[Alberto]

I suspect €120 per cleaning is what your dentist would charge you if you pay directly, but that the insurance pays somewhat less.
I also suspect that like all insurance policies they rely on the fact that many people will buy the insurance but never claim, and so averaged over all their customers it works out.
If they couldn't make a profit on the insurance, then they would have gone bust by now.

Thanks

[Alberto]

If it sounds too good to be true is because ......

My GKK, TK, already refunds 40eur/yr for Zahnreinigung. My last one costed me 119,04 eur.
The total Zahnreinigung cost WITH this extra insurance is actually 16,9 eur/month

Total Zahnreinigugn cost, 2/yr as reccommended by the Praxis:

With extra insurance: 12 * 16,9 = 202,8 eur
Without extra insurance: 2 * 119,04-40 = 198,08 eur

[Alberto]

Update:
I applied to TK for my recent Zahnreinigung(en), and they just refunded 3 x 40eur.
It took just over 12hr, between appication and having the funds into my account!