BSG: Brushing your teeth is your responsibility
The statutory health insurance does not have to pay for regular weekly brushing by a dentist. This also applies if a physically and mentally handicapped person is unable to brush their own teeth, the Federal Social Court (BSG) in Kassel (Az .: B 1 KR 30/16 R) ruled on Tuesday, July 11, 2017.
The plaintiff, who came from the Hanover area and was born in 1975, was unable to brush his teeth because of his disability. The man is in care level III because of spinal stiffening and intellectual disability. His mother was not allowed to do regular oral hygiene with him.
The disabled person had his dentist's teeth cleaned a total of ten times a week at his own expense. The dentist did this with the help of ultrasound, the use of toothbrushes and the introduction of an antibacterial chlorhexidine gel.
His health insurance, DAK-Gesundheit, rejected the application for reimbursement of costs.
The Hanover Social Court, however, ordered the health insurance company to reimburse the plaintiff for 150 euros. The state social court confirmed this decision.
But the BSG now agreed with the health insurance company. Tooth cleaning is a "basically not specifically medical, but generally sensible procedure for the prevention of dental diseases", which the insured person has to provide on his own responsibility. If necessary, however, long-term care insurance covers the needs of people in need of care and of people with disabilities, according to the Kassel judges. fle