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Medical Card Dental Coverage

  • #1
    Registered Users Posts: 495 ✭✭ Rockin


    Current medical card dental coverage as of February 2011

    an examination,
    2 fillings (emergency)
    as many extractions as required


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Comments



  • I think most medical card general dentists would do the extraction for you using your med card, ask when making the appointments.

    you are correct on the entitlements, probably would be a good sticky




  • Just to clarify on post above:

    The examination is 1/year (i.e 1 today 28/03/11, next 1 on 28/03/12
    The 2 fillings are 2/calendar year (i.e between 01/01/11 - 31/12/11)
    also as well as extractions prescriptions are covered and any treatment needed to stop bleeding post extraction!


    don't know if this helps :)




  • Tidied up the thread there was going off topic.

    You can get one checkup a year, 2 fillings a year (white on the front 6 teeth top or bottom, silver at the back) and extractions. Nothing else is covered. Every dentist works the same under the medical card, there is no difference in your entitlements between dentists.

    Items that are NOT covered include: cleanings, gum treatment, whitening, fillings for cosmetic reasons, crowns, bridges, veneers, implants, dentures (sometime they will pay but the dentist has to send for approval), night guards, splints.




  • Just wondering, are folks sure that the 2 fillings covered for med card patients are per calendar year? I think a dentist I spoke to was under the impression that it is from when you last had a filling? In fact it may even have been the dental section of the HSE in my area - can't really recall now. That being, you have say one fiilling in Jan and another in Nov of the same year - you then cannot have another until the following Nov at the earliest - always thought that was a bit weird to say the least! Within a calendar year makes much more sense but any further clarification or more especially links would be welcome. We searched and can't find anywhere where it specifies per calendar year. But of course it makes sense. Thanks.




  • gh


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  • After several phonecalls etc have finally established that the fillings are 2 per calendar year even though every single dentist in the town we live in were telling us the opposite, contacted the HSE in Dublin (the Primary Care Reimbursement section) and were told it is per calendar year. However the checkup is every 12 months, so if you have a checkup lets say in Sept 2010, you can't have anothe until Sept 2011. But if you have say 2 fillings in Dec 2010, you can have another 2 in Jan 2011 (or whenever you need them)

    Also phoned dentists in Cork and Dublin and seems many are under the impression that it is every 12 months for fillings......set them straight on that. It raises questions however for any medical card holders who have paid when they didn't need to pay...are they now entitled to reimbursement? They would have only paid because their dentist would have told them they had to pay, raises a few questions me thinks......




  • marti8 good points but I think the problem lies with the HSE not the dentists.
    The letter we got from the HSE last year very unclear about the start date for the reduced cover and never stated if the patient was half way through a treatment plan whether this work was covered.
    I for one ended up placing a large number of restorations that I did not get paid for, so I can see why dentists are being over cautious. I really think the HSE needs to send each dentist clear guidelines. For example I got a letter from them this week stating they are homogenising the amount they are paying for certain under the line treatments eg protracted periodontal treatment, across all HSE areas. I dont know how much was spent on this futile exercise since they no longer approve any of this treatment.

    As for patients that paid for work if they were told before they had the treatment that they had to pay I don't see the problem (informed consent)




  • marti8 good points but I think the problem lies with the HSE not the dentists.
    The letter we got from the HSE last year very unclear about the start date for the reduced cover and never stated if the patient was half way through a treatment plan whether this work was covered.
    I for one ended up placing a large number of restorations that I did not get paid for, so I can see why dentists are being over cautious. I really think the HSE needs to send each dentist clear guidelines. For example I got a letter from them this week stating they are homogenising the amount they are paying for certain under the line treatments eg protracted periodontal treatment, across all HSE areas. I dont know how much was spent on this futile exercise since they no longer approve any of this treatment.

    As for patients that paid for work if they were told before they had the treatment that they had to pay I don't see the problem (informed consent)

    Yeah, it seems as though the fault does lie more at the HSE's door than with individual dentists. I guess you could ask why dentists didn't contact the HSE to find out the exact rules if they were unsure of them? I mean, that's what I did and I'm not a dentist - I had that information within an hour of begining my phonecalls. But yes, the HSE should have informed dentists although I was told either by one of the dentists I phoned or by the HSE, can't recall which, that a circular was issued outlining exactly what was what and that the rules were only finally finalised last Nove or thereabouts, prior to that there was confusion (still is for many dentist tbh)

    As for patients who've paid (and who may be continuing to pay), that depends I think. I mean lets say Mary had two fliings done in Oct 2010, she needed another one or two done in for arguments sake Feb 2011, she went to her dentist to be told yes you can get them done but you'll have to pay, she paid and had the fillings done. Now she shouldn't have paid. She only paid because the dentist would have told her she had to unless she waited until the following Oct......Who reimburses dear old Mary?




  • The reason for the confusion is because traditionally medical card claims were paid per treatment year, not per calendar year. For instance, if dear old Mary had a cleaning in October 2008 (under the old system) she would not be entitled to another until April 2009.

    Apart from anything else, dentists will be overly cautious on this one because many times we have thought that our patients were entitled to treatment under one scheme or another (usually medical card it has to be said), only to find out when the payment arrives (or doesn't) that we are short of some payments. Who reimburses dear old dentist?




  • Big_G wrote: »
    The reason for the confusion is because traditionally medical card claims were paid per treatment year, not per calendar year. For instance, if dear old Mary had a cleaning in October 2008 (under the old system) she would not be entitled to another until April 2009.

    Apart from anything else, dentists will be overly cautious on this one because many times we have thought that our patients were entitled to treatment under one scheme or another (usually medical card it has to be said), only to find out when the payment arrives (or doesn't) that we are short of some payments. Who reimburses dear old dentist?

    Who reimburses the dentist? That would be an ecumenical matter. I have no idea, if reimbursement is due I would guess that should come from the PCRS. If the rules are unclear or confusing that is a matter to be taken up between the dentist and the PCRS. All I am saying is that confusion exists as to whether med card patients are entitled to 2 free fillings per calendar year or 12 months from the date they had the second free filling done previously. After searching and phoning I now know that it is per calendar year. I've informed dentists in my own town of this (and they were grateful for me doing so) as they were working under the assumption that it was every 12 months and not per calendar year - is it confusing, yes. Should the PCRS have communicated better with the dentists, yes. Should dentists have contacted the PCRS, as I did, to clarify matters if they weren't sure, yes (some did but never heard back from the PCRS) Although in the first instance of course the PCRS should have issued clear, easy to understand guidelines for dentists.


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  • I think a problem her Marti8 is that what we dentists hear from PCRS and what actually happens are often two different things. We were all under the assumption that all treatments go by the 'treatment year' as this has always been the way. HSE/PCRS seemed to decide in January that the two fillings would be allowed per calendar year. They did not announce this to anyone, but just let the news filter through. e all know from experience not to trust a general operator who picks up the phone at PCRS, as misinformation i all too common.
    I have placed '2 new fillings for 2011' on patients to get back the grand sum of €0.00 written on my payment schedule. The reason given? 'Patient has already had 2 fillings'.
    Regarding your reimbursement question, I think a fair way is to let the dentist apply for the payment and if successful then reimburse the patient the amount paid.




  • marti8 your under some illusion that the HSE communicate with dentists and explain the rules and then stick to the rules. The HSE also has the miraculous ability to unilaterally change contracts as they see fit.

    While this system may be frustrating for patients, it is intolerable for dentists.




  • marti8 your under some illusion that the HSE communicate with dentists and explain the rules and then stick to the rules. The HSE also has the miraculous ability to unilaterally change contracts as they see fit.

    While this system may be frustrating for patients, it is intolerable for dentists.

    No, I never said that. I said they should communicate properly with dentists. I have no doubt it must be frustrating for dentists not knowing what is what, all I'm saying is that I've informed dentists where I live what is what and also gave them the number for the PCRS if they want to follow that up. Someone had to. It's best for everyone that the rules are known, this reduces confusion. Now as for whether the PCRS are correctly paying dentists for work done on med card patients, that's totally an issue between dentists and the HSE. I'm simply coming at it from a medical card patients perspective.




  • Heroic stuff here. So if the dentist doesn't get paid, that's cool as long as the patient gets treated and they don't have to pay. What a great world that would be to live in.

    Marti8 you seem to be well informed of the inner workings of the HSE, the DTSS and the PCRS. I commend you for that. However, as I, and ALL of the other contractors in this scheme will tell you, the only way to determine what the HSE is and isn't paying for is by looking at what you haven't been paid for when you get your cheque 2-3 months later. This is despite what you have been told. Lets just say there has been unilateral movement on contracts, no communication within or without the HSE and the PCRS has contradicted itself on more than one occasion.

    I think the whole system is, was and ever shall be, world without end, a joke. The only solution to fixing this is to scrap the current system and introduce the three C's: capitation, computerisation and compensation. That would be an initial increase in cost for the HSE but would save millions in the long and increase the quality of provision of service almost immeasurably. And the dentist wouldn't be left out of pocket for doing his job.




  • Big_G wrote: »
    Heroic stuff here. So if the dentist doesn't get paid, that's cool as long as the patient gets treated and they don't have to pay. What a great world that would be to live in.

    Marti8 you seem to be well informed of the inner workings of the HSE, the DTSS and the PCRS. I commend you for that. However, as I, and ALL of the other contractors in this scheme will tell you, the only way to determine what the HSE is and isn't paying for is by looking at what you haven't been paid for when you get your cheque 2-3 months later. This is despite what you have been told. Lets just say there has been unilateral movement on contracts, no communication within or without the HSE and the PCRS has contradicted itself on more than one occasion.

    I think the whole system is, was and ever shall be, world without end, a joke. The only solution to fixing this is to scrap the current system and introduce the three C's: capitation, computerisation and compensation. That would be an initial increase in cost for the HSE but would save millions in the long and increase the quality of provision of service almost immeasurably. And the dentist wouldn't be left out of pocket for doing his job.

    All I am sying is that is between the dentists and the HSE, not between the dentists and the patient. I mean if a dentist really doesn't like the scheme they are free to opt out. Of course dentists should be paid for the work they do, of course - as should everyone. However if they aren't for whatever reason then that is an issue between them and the HSE. The patient is simply the patient, most won't know who pays what to whom and when and why, they'll simply know, oh I need a filling or two, had two done last Nov it's now April I can now get another one or two - the goings on between the dentists and the PCRS doesn't concern the average patient. But yes, one things absolutely correct, dentists should be paid for the work they do.




  • Going a bit off topic here let keep things simply for information.

    Cheers




  • So i can get my two broken teeth extracted for free if i send away for a medical card?




  • SIBERIA wrote: »
    So i can get my two broken teeth extracted for free if i send away for a medical card?

    If you need them extracted and you HAVE a full medical card, yup.




  • Why is it that the list here is much shorter that the one on the HSE website?

    "Medical Card: Fillings, Cleaning/polishing, Extractions, Dentures and Root Canal Treatment."

    Is the list on the hse website not actually accepted by dentists?




  • Panda wrote: »
    Why is it that the list here is much shorter that the one on the HSE website?

    "Medical Card: Fillings, Cleaning/polishing, Extractions, Dentures and Root Canal Treatment."

    Is the list on the hse website not actually accepted by dentists?

    Last updated on: 19 / 04 / 2010


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  • Hi all please bare with me as I just joined site not familiar with the workings or who will see this post.I have a problem well a couple actually as I have a few troublesome back teeth and I just happen to have an unspeakable fear of a visit to the dentist.also due to the current climate I have not worked since may this year despite what seems thousands of applications.my problem is two fold,I have been in pain for the last two weeks but can't afford to pay for treatment,young family takes priority,secondly the fear I have adds to the problem are there any dentists that would put you out under gas or something similar and do all work needed while you are asleep ?




  • Just wondering if you have a tooth filled and then need it re done a year after, is that covered or not? I know you're allowed 2 a year, but the same one?




  • Just wondering if you have a tooth filled and then need it re done a year after, is that covered or not? I know you're allowed 2 a year, but the same one?
    Afaik, no. If a tooth has been filled within the last five years it wont be covered by the medical card. You'll have to pay privately to get it replaced.




  • fonpokno wrote: »
    Afaik, no. If a tooth has been filled within the last five years it wont be covered by the medical card. You'll have to pay privately to get it replaced.

    so u go to dentist A now and get a filling, then you go to dentist B 16 months later and say the tooth hurts and u need it filled, dentist B will fill the tooth no questions asked




  • But the dentist may not get paid, this may not matter to you but it matter to the dentists and his staff and all the people depending such payments. I think to knowingly do this is dishonest at best and social welfare fraud at worst.




  • so u go to dentist A now and get a filling, then you go to dentist B 16 months later and say the tooth hurts and u need it filled, dentist B will fill the tooth no questions asked[/QUOTE]


    your mystic powers would put keith barry to shame!
    cant speak for dentist a or b:rolleyes:.....but i'll tell you what i do.
    key in every med card patients rsi no onto the online checker (now cyberjuice ever heard of that before?:p) to check if i'll get paid prior to doing any procedure. if not, it's cash up front or PFO.

    as regards your treatment planning above in bold it'll be a cold day in hell before any dentist worth his salt will "fill" a tooth in pain!

    now cyberjuice try con/defraud someone else!:eek:
    i'll return to work @2 with renewed zeal knowing some of the clientele upon whom my taxes are spent.




  • Just out of curiousity, have the entitlements changed for medical card holders since the OP was updated (last year)?

    Have there been any changes in the 2012 budget regarding medical cards/dental coverage?

    Also, does anyone know where you stand regarding wisdom tooth extraction and medical cards? I've searched around and seen this asked a few times but it seems to vary in answer and all the threads are pre-2012 anyway, so not sure if the information is still applicable.

    Cheers.




  • Can you get the teeth cleaned, scale and polish done on the medical card?




  • Can you get the teeth cleaned, scale and polish done on the medical card?

    Afraid not.


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  • KKV wrote: »
    Just out of curiousity, have the entitlements changed for medical card holders since the OP was updated (last year)?

    Have there been any changes in the 2012 budget regarding medical cards/dental coverage?

    Also, does anyone know where you stand regarding wisdom tooth extraction and medical cards? I've searched around and seen this asked a few times but it seems to vary in answer and all the threads are pre-2012 anyway, so not sure if the information is still applicable.

    Cheers.

    Med card will pay a maximum of 70euro (less 20% witholding tax) for difficult extractions. That would include wisdom teeth. You probably would have to search quite a bit to find someone to agree to do it for that (not even in Budapest I'd say)


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