Decade dental request for dental history

rodge123

I'm with decade a few years now on level 3 plan and have never had any issue with claims.

I hadn't been to dentist in about 2 years but went recently and had to get a few fillings and a crown.
Quite a lump of money to stump up!

Anyway, submitted my claim form to them and received a letter the other day - before they will access it they want permission to contact my dentist to see a full dental history, or for me to send it to them.

I'd say they would be paying me back about 700 based on the treatments.

It's not like my dentist if I have done anything dodgy.

Are they looking for an excuse to avoid paying out some of costs?

davo10

Because DeCare pay you directly and you personally submit the claim form, they just want to make sure the treatment you are claiming for has actually been carried out. They are not checking if the dentist is dodgy, they are checking to see if you are making a bogus claim for reimbursement.

DeCare sometimes phone my Clinic for patient records, I always refuse, they are not entitled to confidential medical records, they know this, what if you have a medical condition, do you want someone from DeCare knowing this?

Just provide receipts, that is all they are entitled to.

rodge123

davo10 wrote: »

Because DeCare pay you directly and you personally submit the claim form, they just want to make sure the treatment you are claiming for has actually been carried out. They are not checking if the dentist is dodgy, they are checking to see if you are making a bogus claim for reimbursement.

DeCare sometimes phone my Clinic for patient records, I always refuse, they are not entitled to confidential medical records, they know this, what if you have a medical condition, do you want someone from DeCare knowing this?

Just provide receipts, that is all they are entitled to.

I already provided recipes with the form and dentist notes.
They quoted something from terms and conditions about their right to request these details, I take a look later and see exactly what they are referring to

davo10

rodge123 wrote: »

I already provided recipes with the form and dentist notes.
They quoted something from terms and conditions about their right to request these details, I take a look later and see exactly what they are referring to

The dentist is not party to that contract nor the t&cs. The dentist will have no problem at all with copying your chart and sending to you once you submit a written request. But the dentist will not send your notes directly to DeCare.

But you should be a little concerned about your medical history sitting on an office desk in Claremorris for god knows who to see.

btkm8unsl0w5r4

As stated above Davo10 is exactly right. The dental records are the property of the dental clinic, you have the right to a copy any time you want. However no third part can request them from the dental clinic.

Having said that, and being a great believer in data privacy. Your contract likely states that the insurer can get your records prior to settling any claim. If you have nothing to hide, then hide nothing. Redact the medical questionnaire from your records, only dental notes are pertenent.

Remember also if you claimed tax relief on the full cost of the crown, that the insurance claim for the same item has tax implications.