Als IGEL – Leistungen werden Leistungen bezeichnet, die ein Arzt erbringen kann, die jedoch nicht im Leistungskatalog der Gesetzlichen Krankenkassen erfasst sind. Diese Individuellen Gesundheitsleistungen müssen vom gesetzlich Versicherten selbst bezahlt werden, wenn er sie in Anspruch nimmt.
Es gibt zwar Listen, auf denen verschiedene IGEL-Leistungen zusammengetragen sind, jedoch ist diese sehr unübersichtlich und nicht vollständig, denn Ärzte können Zusatzleistungen anbieten, die sie entweder selbst entwickelt oder von Firmen übernommen haben. Der Leistungskatalog ist breit gefächert und ändert sich ständig. Patienten haben kaum eine Chance, den medizinischen Nutzen sowie Qualität und Preis der Angebote zu überprüfen und miteinander zu vergleichen. Dies ist auch der grund, warum IGEL – Leistungen häufig als “nutzlos” und “Geldmacherei” bezeichnet werden.
Grundsätzlich können IGEL – Leistungen in zwei Gruppen unterteilt werden:
- Leistungen, die die Gesetzlichen Krankenkassen nicht bezahlen, die jedoch sehr sinnvoll für den Behandlungserfolg sind. Es handelt sich in der Regel um Behandlungsverfahren, die mit modernen, innovativen Verfahren durchgeführt werden, die es noch nicht gab, als der Gebührenkatalog der Krankenkassen erstellt worden ist.
In der Zahnarztpraxis wären das zum Beispiel: Professionelle Zahnreinigung, Sauerstoff- oder Ozontherapie bei Parodontitis, Spülungen von Wurzelkanälen. Auch Zahnimplantate sind keine Kassenleistungen, bringen dem Betroffenen jedoch eine sehr viel höhere Lebensqualität als Prothesen und sind daher im Einzelfall sehr sinnvoll.
Auf andere medizinische Bereiche bezogen, sind es:
- Früherkennungs- oder Vorsorgeuntersuchungen.
- Ultraschall der Brust, die Glaukom-Früherkennung (Grüner Star)
- Ultraschall der Eierstöcke oder der Halsschlagader.
Manche dieser Untersuchungen übernehmen die gesetzlichen Krankenkassen nur in bestimmten Risikofällen (familiäre Vorbelastung) oder bei begründetem Krankheitsverdacht. In allen anderen Fällen, in denen die zusätzlichen Untersuchungen auf eigenen Wunsch der Patient:innen ohne medizinische Notwendigkeit erfolgen, müssen die Kosten selbst bezahlt werden.
- Leistungen, die auf Verlangen durchgeführt werden, medizinisch jedoch nicht notwendig sind. Dies sind zum Beispiel alle Maßnahmen, die aus ästhetischen Gründen durchgeführt werden. Auf den Zahnarzt bezogen wären das: Zahnbleaching, Zahnschmuck, Versorgung der Schneidezähne mit Veneers.
Auf andere medizinische Bereiche bezogen sind es:
- Ärztliche Atteste und Serviceleistungen für Freizeit, Sport und Urlaub
Beispiele: Sportmedizinische Untersuchungen, Beratung vor Fernreisen und Reiseimpfungen, Untersuchung und Bescheinigung bei Reiserücktritt - Medizinisch-kosmetische Leistungen
Hier besteht meist keine medizinische Notwendigkeit, etwa bei Schönheitsoperationen oder Entfernung von Tätowierungen - Psychotherapeutische Leistungen (z. B. Paartherapien)
Was ist eigentlich Kassenleistung beim Zahnersatz?
“Die Kassenleistung ist die preiswerteste Lösung beim Zahnersatz und wissenschaftlich abgesichert. Im Härtefall ist sie kostenfrei.” Das sagt die Verbraucherzentrale. Jedoch ist die preiswerteste Lösung meist nicht diejenige, die am besten sitzt und mit der man am besten kauen kann.
Die Krankenkassen ermitteln jedes Jahr neu, wie hoch der Festzuschuss sein darf. Aus diesem Grund muss ein sogenannter Heil- und Kostenplan aufgestellt werden. Dieser muss vor Behandlungsbeginn an die Krankenkasse zur Bewilligung gesendet werden.
Für jeden Befund hat das oberste Beschlussgremium von Krankenkassen, Ärzten und Zahnärzten festgelegt, was die Regelversorgung ist. Diese muss laut Sozialgesetzbuch ausreichend, zweckmäßig und wirtschaftlich sein.
Was bedeutet Regelversorgung?
Was bei Kronen, Brücken und Prothesen Standardtherapie ist, heißt Regelversorgung. Diese ist von Krankenkassen und Zahnärzteschaft festgelegt. Darauf haben Versicherte einen gesetzlichen Anspruch. Ist eine Krone oder Brücke im Seitenzahnbereich nötig, ist Nicht-Edelmetall die Regelversorgung - nicht nur weil es preiswert ist, sondern auch, weil es bei Lebensdauer, Stabilität und Passgenauigkeit weiterhin gute Ergebnisse erzielt. Im sichtbaren Zahnbereich bezuschussen die Kassen eine zahnfarbene Teilverblendung.
Was bedeutet „gleichartige“ oder „andersartige“ Versorgung?
Wenn eine zahnärztliche Arbeit über die Regelversorgung hinausgeht, wird weiterhin zwischen der gleichartigen und andersartigen Versorgung unterschieden.
Es gibt demnach jenseits der Regelversorgung zwei Möglichkeiten:
- Die „gleichartige Versorgung“ ist eine Lösung, die die Kassenleistung beinhaltet, aber auch zusätzliche Leistungen. Wenn etwa eine Metall-Krone oder -Brücke im Seitenzahnbereich keramisch verblendet wird, ist das mehr als die Kassenleistung, aber immer noch eine Krone oder Brücke. Dann rechnet der Zahnarzt nur die Zusatzkosten für eine Verblendung privat ab, den Rest gesetzlich.
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