What does the medical card cover?

donegal11

hi, just wondering what the medical card now covers in relation to dental treatment there seems to be confusion between it and PSRI treatment cover. My understanding is that it still covers routine check up and basic treatment such as fillings. Am i right or will it only cover emergency treatment from now on with the budget cut backs?

shellyshoes

hey the med card now only intitles u to 1 dental exam per year and two emergency fillings per year.(silver fills) on back teeth white on front six teeth.and extractions.it no longer covers scale and polishes,dentures or root canal tx.

PRSI is now only one exam per yer.

Hope this helps

ballsymchugh

to add to shelleyshoes, it can sometimes cover dentures and root fillings on front teeth. your dentist will have to write a letter to the local dental officer pleading your case using persuasive language.
not all dental officers will approve anyway, it may depend on the local budget or if their coffee isn't good in the morning. and you're very unlikely to get a lower denture.
you definitely won't get cleaning on it anyway.
always worth a shot though.

storm2811

Is the hygenist free?Like cleaning and that?
I seem to be getting free cleanings every 6 months,they ring me!

ballsymchugh

not usually, unless the hygienist did the cleaning and the dentist claimed it themselves.
the med card won't cover that now anyway.

storm2811

Strange,they called me last week for a cleaning and she said she'd be ringing me again in a few months,with no mention of a fee.
I'm not complaining anyway!

shellyshoes

im a dental nurse and the only tx were doin under mc scheme is one exam a year and 2 fills...everything else is pvt..no point in wasting time writing letters as it will not be approved..sadly we will jus have to face facts

ballsymchugh

shellyshoes wrote: »

im a dental nurse and the only tx were doin under mc scheme is one exam a year and 2 fills...everything else is pvt..no point in wasting time writing letters as it will not be approved..sadly we will jus have to face facts

that's funny, i'm a dentist and have had quite a few approvals sent back to me. come to think of it, i don't think i've had anything refused. there's no point in condemning the medical card holder to a poor oral state just because you can't be arsed to write a letter on their behalf.

storm, the next time they call, make sure you know the state of it before you make your appointment!!

shellyshoes

as u said above it prob depends on your area.I myself and the dentist have sent off special approvals with no such luck..we often provide 1st stage root canal as mark it as emergency fill..but dentures are a loss anyway as we did not benifit

ballsymchugh

it's all in the wording

storm2811

ballsymchugh wrote: »

storm, the next time they call, make sure you know the state of it before you make your appointment!!

Will do,found it a bit odd alright,it could be because I had a tooth extracted a few weeks before?

My mum just got new dentures on the medical card because they were broken,took a while though between letters and appointments and the like.

shellyshoes

i dont get paid enough to be dealing with the like i can only try my best..its the dentists responsibility at the end of the day

ballsymchugh

i wouldn't expect my nurse to write the letters. absolutely no offense intended, but the last time a nurse wrote something for me was 7 years ago and almost screwed me up, so if i write, i am to blame.

shellyshoes

no offence taken..id prefer the dentist to write the letters and sign there own forms but fat chance of tat happening anytime soon..and its always the nurses fault when something goes wrong instead of doing it themselves in the first place in my work place..really should find new job ha

Big_G

I've got to weigh in on this one. Several cases of fillings (one of the two now allowed per year) have been rejected by the medical card as they were deemed not an emergency.

So in our practice we have stopped applying. Private fees now only apart from a check up.

day dreamer

It is a really sad state of affairs for those who need dental treatment the most. We should target our ire at the HSE and Dept of health

I feel we should to apply for treatments and treat each patient on their needs. It is ridiculous that some areas approve and other wont. Then if it is not approved then the patient will either have to pay or go without.

ballsymchugh

spent about 30 mins yesterday writing out clinical justification for treatment provided on a fair amount of cases. big g, i'm going to keep an eye on the next sched that comes in. would be interesting to know the difference esp when you're about a 10 minute drive away.

vishal

another hit for dentistry and GPs disguised as something else http://www.irishtimes.com/newspaper/frontpage/2010/0710/1224274422280.html?via=mr

Big_G

Ballsy look at where you are located and where I am located. This happened to me before when I was working in two different practices, one in an area with low socioeconomic status residents and the other with middle income families and the first one nothing was ever rejected for approval and in the second one everything was rejected. This is anecdotal of course. I'd never accuse the hse of unbalanced funding to different areas.

ordinary_girl

Is there any way at all to get root canal treatment on the medical card? Don't fancy losing any more teeth unnecessarily

hg03 eyu

The supreme court yesterday upheld the injunctions secured by two dentists against changes to the DTSS (medical card).
Does that imply that all dentists can now operate the medical card system as normal?
Is the IDA covering the legal costs of this challenge?

ballsymchugh

Big_G wrote: »

Ballsy look at where you are located and where I am located. This happened to me before when I was working in two different practices, one in an area with low socioeconomic status residents and the other with middle income families and the first one nothing was ever rejected for approval and in the second one everything was rejected. This is anecdotal of course. I'd never accuse the hse of unbalanced funding to different areas.

:pac::pac::pac::pac::pac:

i'm pretty sure it's down to whoever makes the coffee in the hse offices. it just happens that where i am that coffee is good. some of my friends that are working in other pretty well to do areas of the country are getting approvals for their treatment. i know that in Co. Louth, there was a lot of stuff refused before the changes. God knows what it's like there now.

hg03, as far as i know, the injunction applies to those two dentists alone. the ida are pushing that it should be applied fully with the precedent already set to save the hse having to go to court for every dentist that provides the treatment.
of course, if they stuck to their original contract and gave the 3 months notice, the scheme would be coming to an end one of these days and there wouldn't be much that could be done.
also, don't the losers pay costs??

rest energy, you can get a root canal treatment on one of the front 6 teeth if your approval is successful.

hg03 eyu

Ballsy, unsuccessfull parties or losers as you put it generally do have costs awarded against them. However, the main high court challenge will not heard until October. That is when very substantial legal costs may arise.

Generally I feel that the HSE cannot treat one group of contracting dentists differently to another group of contracting dentists who are operating under the same contract.

ballsymchugh

ida email sent out yesterday

I am pleased to advise you that the Supreme Court has today lifted the stay on the injunction granted by the High Court to Drs James Turner, Chair of the IDA General Practitioners Committee, and Dr Martin Reid. This means they are entitled to practice in accordance with the full terms of the DTSS contract negotiated by the HSE and the Department of Health and Children. The Supreme Court also awarded costs to Drs Reid and Turner in regard to this application to the Supreme Court.
The HSE has refused to accept that Drs Reid and Turner are representative of all IDA members participating in the DTSS. It is now expected that the substantive breach of contract case, being taken by Drs Reid and Turner, which is supported by the Association will not be heard in the current law term.