Not every dental invoice is reimbursed in full. There are several reasons why your payout might be lower than expected—from how the treatment was billed to what your plan includes. Understanding these can clarify why a claim is not fully paid.
Why is my dental insurance claim partially reimbursed?
Several factors can affect how much is reimbursed under your Feather dental insurance, including:
The treatments listed on the invoice
Whether the treatments are covered by your selected dental plan
Annual reimbursement limits of your policy
How the treatment was billed (e.g. severity factor or private vs. public billing)
What is the severity factor and how does it impact reimbursement?
Dental invoices in Germany list a severity factor (Steigerungsfaktor) that reflects how complex or time-consuming a procedure is. Our plans reimburse up to a factor of 3.5. If your invoice shows a higher factor, we’ll only reimburse the portion up to 3.5. Anything beyond that becomes an out-of-pocket cost.
How do yearly coverage limits affect dental claim reimbursements?
Our Basic and Advanced dental plans have yearly limits during the first two calendar years that cap reimbursements for certain treatments to a combined total of €300 (€150 each year). These treatments include:
- High-quality fillings
- Root and periodontitis treatment
- Mouth or bite guards
- Pain treatments such as local anesthesia, acupuncture, or hypnosis
From the third year onward, these treatments are no longer subject to a yearly limit.
What are the reimbursement limits for tooth replacement procedures?
The Advanced dental plan covers tooth replacement procedures, but reimbursement rates depend on the coverage level you selected: 80%, 90%, or 100%. Even with the highest level, there may still be yearly tooth replacement limits depending on how many teeth were missing when you signed up. The Basic plan does not cover tooth replacement procedures.
Are all dental treatments covered by our dental insurance plans?
Not all dental treatments are included in our coverage. Each treatment on an invoice is identified by a code from the fee schedule of dentists (GOZ). Treatments not covered by your dental plan are not reimbursed. A few common examples that are not covered:
GOZ 4020: Local treatment of oral mucosa conditions
GOZ 4025: Subgingival application of antibacterial medication
These treatments may be prescribed alongside routine cleaning but are not part of the covered services.
What should I do if I do not understand my partial reimbursement?
If you have reviewed your invoice and coverage details but still do not understand the reason for a partial reimbursement, please contact our support team. We can help you review and clarify your claim.