My daughter, who is 16 years old, was treated for pulpitis with all the accompanying manipulations. After its completion, we were told that the 5 procedures required under the National He alth Insurance Scheme will also be absorbed and an additional BGN 50 must be paid. Is this correct?
Zlatka Dobreva, city of Plovdiv
NHOK pays fully or partially for the following dental services for he alth insured persons (HOL) up to the age of 18:
• Comprehensive examination with taking oral status, once for the relevant year, for which the additional payment from ZOL is BGN 1.80
• Four treatment activities, two of which can be treatment of pulpitis or periodontitis of a permanent tooth:
- obturation with chemical composite or amalgam, for which no additional payment is due from ZOL.
- temporary tooth extraction with anesthesia - ZOL does not owe a surcharge.
- permanent tooth extraction with anesthesia - also no additional payment is due from ZOL.
- treatment of pulpitis or periodontitis of a temporary tooth - additional payment from ZOL is BGN 4.70
- treatment of pulpitis or periodontitis of a permanent tooth - co-payment from ZOL is BGN 12.30
Outside of the regulated additional payment for activities from the budget of the NHIF, the he alth insured owes a payment or additional payment when, during the treatment and diagnostic activities, he expressly prefers materials, means or methods not included in the specified package, when the necessary treatment concerns dental activities, not included in the agreed package and when the patient has received his due volume of dental activities
Since it is not clear from the question how many teeth were treated, in case your daughter's rights are violated, you can file a complaint with the director of the relevant RHOC. In the complaint, you need to provide specific data in order for the case to be checked.
