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Wisdom Teeth Extraction & VHI

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  • 31-08-2015 8:21pm
    #1
    Lollipops23
    Registered Users Posts: 5,420 ✭✭✭


    Hi- went for a check up with my dentist today and apparently I need all 4 of my wisdom teeth out.
    I have VHI with work (dental included). The dentist quoted me €1400 for the surgery- do I need to pay this upfront? I don't have that kind of cash lying around, even if I can claim it back on my insurance!
    Thanks!


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    #2
    coylemj
    Registered Users Posts: 25,362 ✭✭✭✭coylemj


    With the exception of inpatient treatment in hospitals which have an agreement for direct payment, VHI tend to only pay after the event so you typically pay for the medical/dental service and then submit a claim. That applies to pretty much all outpatient GP/consultant/dental/diagnostic services.


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    #3
    Oral Surgeon
    Registered Users Posts: 3,240 ✭✭✭Oral Surgeon


    coylemj wrote: »
    With the exception of inpatient treatment in hospitals which have an agreement for direct payment, VHI tend to only pay after the event so you typically pay for the medical/dental service and then submit a claim. That applies to pretty much all outpatient GP/consultant/dental/diagnostic services.

    Sorry coylemj but this is not the case.

    Vhi and other medical insurers have direct pay agreements with most oral surgeons registered with them. This is true for their own private clinics and when they work in private or public hospitals.
    First are you being seen by a fully participating oral surgeon?
    Have you insurance for over 6 months?
    Are your wisdom teeth impacted/ unerupted?

    If yes to all of the above, then the removal of the impacted or unerupted wisdom teeth is covered. There may be some small additional expenses but nowhere near 1400!!

    Good luck,
    Os


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    #4
    coylemj
    Registered Users Posts: 25,362 ✭✭✭✭coylemj


    I'm on a VHI company plan which includes dental cover but according to the schedule of benefits it only pays me €40 per visit to a 'dental practitioner' up to a maximum of 12 visits in the year. I think you'll need to ask the OP exactly what level of cover he has before you can be sure that he will get anything like the cover he's going to need to pay for that treatment.

    As I understand it, you need a separate 'dental plan' to give you the cover described by OS above.


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    #5
    marco_polo
    Moderators, Science, Health & Environment Moderators Posts: 10,079 Mod ✭✭✭✭marco_polo


    Wisdom teeth removal wouldn't normally be considered as dental work by health insurers though, I'd imagine even the most basic of plans would cover it.


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    #6
    Oral Surgeon
    Registered Users Posts: 3,240 ✭✭✭Oral Surgeon


    Sorry, wrong again, the removal of impacted/ unerupted wisdom teeth is covered under the general medical and surgical plans and not the dental plans....
    coylemj wrote: »
    I'm on a VHI company plan which includes dental cover but according to the schedule of benefits it only pays me €40 per visit to a 'dental practitioner' up to a maximum of 12 visits in the year. I think you'll need to ask the OP exactly what level of cover he has before you can be sure that he will get anything like the cover he's going to need to pay for that treatment.

    As I understand it, you need a separate 'dental plan' to give you the cover described by OS above.


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    #7
    coylemj
    Registered Users Posts: 25,362 ✭✭✭✭coylemj


    Oral Surgeon wrote: »
    Sorry, wrong again, the removal of impacted/ unerupted wisdom teeth is covered under the general medical and surgical plans and not the dental plans....

    Strange then that the dentist didn't inform the OP of that fact, given the large estimate he was given for the work.

    What I mean is that you'd have expected the dentist, having delivered the estimate of €1,400 to the OP to have quickly followed it up with something along the lines of: 'I know that's a lot of money but most VHI plans will cover it and they will pay me direct so you won't have to fork out the money'


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    #8
    Oral Surgeon
    Registered Users Posts: 3,240 ✭✭✭Oral Surgeon


    Most dentists are not registered with the Vhi to provide these treatments, most oral surgeons are.... The patient is caught in the middle and ends up losing out...
    coylemj wrote: »
    Strange then that the dentist didn't inform the OP of that fact, given the large estimate he was given for the work.

    What I mean is that you'd have expected the dentist, having delivered the estimate of €1,400 to the OP to have quickly followed it up with something along the lines of: 'I know that's a lot of money but most VHI plans will cover it and they will pay me direct so you won't have to fork out the money'


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    #9
    Lollipops23
    Registered Users Posts: 5,420 ✭✭✭Lollipops23


    VHI have come back saying that my policy does not cover surgical extraction (despite having both health and dental policies; you'd think one of them would have me covered!!). Might look up north. Insanity.


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    #10
    Oral Surgeon
    Registered Users Posts: 3,240 ✭✭✭Oral Surgeon


    Lollipops23 wrote: »
    VHI have come back saying that my policy does not cover surgical extraction (despite having both health and dental policies; you'd think one of them would have me covered!!). Might look up north. Insanity.

    Are your wisdom teeth impacted?


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    #11
    Lollipops23
    Registered Users Posts: 5,420 ✭✭✭Lollipops23


    Oral Surgeon wrote: »
    Are your wisdom teeth impacted?

    One is, on the lower jaw.


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    #12
    Oral Surgeon
    Registered Users Posts: 3,240 ✭✭✭Oral Surgeon


    Lollipops23 wrote: »
    One is, on the lower jaw.

    OK
    ask the vhi are you covered for 2976 (removal of one lower impacted tooth)
    ask if the guy you are seeing is registered to do this, likely not...

    If the others are surgical extractions, the vhi dental have a section for that on their new form https://www.vhi.ie/downloads/dental-claimform.pdf


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