20% reduction for orthodontic treatment with health care provider?

rocksteady36

Has anyone had any issue with the 20% discount a certain health care provider is offering if they use a certain orthodontist in dublin 2 area.

I recently went there and thought i was getting a 20% discount but turns our it only applies if you spend over 4K on your treatment.

dudara

Moved to Banking & Insurance & Pensions

dudara

NuMarvel

I haven't had this done myself, but, presuming this is Aviva you're referring to, I had a look at the Aviva Health rule book, and on Page 9 of the current rules for the I/We/Me Plans, it has the following:

Orthodontics
You can now receive up to 20% off orthodontic treatment over €4,000.

So, on the face of it, it seems to be prefectly fine and in line with their terms and conditions.

However, on their website, in the member benefits section, there's no mention of the €4,000 threshold:

Orthodontics

As a health member with Aviva you can now receive up to 20% back on the cost of orthodontic treatments at Smiles Orthodontics.

Now, the rule book is the legal contract, and they are within their rights to follow that to the letter. But, given that this threshold isn't mentioned anywhere else, and it's a fairly big threshold to reach, you could argue the case and ask Aviva to make some contribution towards the costs.

If you feel you haven't received a satisfactory response, you could also bring it to the Financial Services Ombudsman who deals with insurance complaints after they've been through an insurer's internal complaints procedures. I also wonder if it's worthwhile bringing to the attention of the Advertising Standards Authority, as it is a fairly significant clause.

Of course, the one question you will be asked, and I think it's a valid question, is if you checked the cover or the price before getting the treatment done?

rocksteady36

Thanks for the reply NuMarvel,

What rulebook do you have. A supervisor said this to me but I said I have not received this book.

I received the 'membership handbook - your guide to using Level 2 Hospital and level 2 everyday'

Page 9 in that handbook has nothing to do with orthodontics. It details consultants fee, in patient scans, in patient stress benefits & ambulance cost.

The only page that refers to orthodontic treatment is page 23. This details the same info as the website and does not mention the 4K threshold etc.

I have not got the treatment done yet, it takes 18 months to finish orthodontic treatment. But I have paid the 95 euro consultation fee, it covered two meetings, one for scans and the second to discuss treatment.

I discussed the discount when arranging the consultation by phone, at the first consultation with a dental nurse and no one ever said anything about the 4K threshhold, until i was walking out the door at the second meeting.

I was told the owner of dental clinic set up a 10% discount 'as a goodwill gesture' because so many people had been mislead by the ad. the health care company rang them and they now deny saying this, they claim goodwill gesture was never said but it is in fact a discount. I don't see anything about a 10% discount, so are they calling me a liar? But theres nothing to back up a claim of a 10% discount in my hand book or website, maybe its in your book, but they told me it was a goodwill gesture. Very messy.

My case is that i want the 20% discount advertised on website and in my handbook.

I mean if i got the handbook for my level 2 and it says nothing about 4K and the ad says nothing and the dental clinic only tell you after you pay 95 euro, then I think I should get the 20%, its nearly 400 euro discount i am losing.

NuMarvel

The handbook I'm looking at is here. Orthodontics is mentioned on Page 9 of that book, so it might be the case that they've updated it since your renewal and only the most recent version is online.

It doesn't matter if that's the case or not though, because the one that's relevant is the one you were sent when you last renewed (or joined if it's still your first year). (the rule book and the handbook are the same thing btw.)

According to what you're saying, your handbook doesn't mention a threshold, so I don't see how Aviva can apply it in your case.

For clarity, ring Aviva again, and tell them you've looked through the handbook and can't find mention of the €4,000 threshold. Ask them where it's referred to in the handbook. If it isn't on the page they refer you to, then tell them so, and ask them how you can identify which version of the handbook you have so that they can look at the same version. The terms and conditions may have changed during the year, but this only applies at renewal, the terms can't change mind policy year, unless it's specifically noted (e.g. hospitals covered, etc).

This may also explain the 10% discount you mentioned, which is mentioned in the book I link to above. Avivia and Smiles may have introduced at the same time as the €4000 threshold to mitigate any adverse reactions.

Hope that helps matters. If Aviva say anything else about the terms and conditons/handbook/rule book, get them to refer you to where it says that in your handbook, because that is your most recent contract.

rocksteady36

I spoke to the HIA and they realised same, that I was sent a different version of the handbook, may be the previous one to the one online.

So they said i should be entitled to 20% and they are contacting aviva on my behalf.

Thanks for your help.

NuMarvel

Why do you need the HIA when you've got me?

That's great news, let us know how you get on!