PRSI Dental benefit

Thegalwayman

ANyone know exactly whats going to covered by PRSI from next week?

Enrico Palazzo

http://www.leitrimobserver.ie/news/home/278351/increased-prsi-dental-benefit-scheme-treatments-from-saturday.html

k mac

Sorry to bump an old thread I visit my dentist twice a year when I see the hygienist both times for a cleaning and the dentist once for a check up on my last visit in January I seen both and paid 70 euros for the cleaning and the dentist was my annual check up I seen the hygienist today and was charged 70 again. I asked the receptionist should was this not covered by the PRSI and she told me no that my appointment next January would be covered . Confused and think I'm being done.

kindalen

How long are you paying PRSI?

k mac

23 years

TheDriver

Moved to state benefits forum

Turnipman

k mac wrote: »

I visit my dentist twice a year when I see the hygienist both times for a cleaning and the dentist once for a check up on my last visit in January I seen (saw) both and paid 70 euros for the cleaning and the dentist was my annual check up

I seen (saw) the hygienist today and was charged 70 again.
I asked the receptionist should was this not covered by the PRSI and she told me no that my appointment next January would be covered . Confused and think I'm being done.

Dental Benefit.

Under this scheme, the Department pays the full cost of an oral examination once a calendar year.

Since 28 October 2017, a payment of €42 towards either a scale and polish or - if clinically necessary - periodontal treatment, is also available once a calendar year.

If the cost of either cleaning or periodontal treatment is more than €42, you must pay the balance - capped at €15 for a scale and polish. There is no cap on the balance charged for periodontal treatment.

Treatment is provided by private dentists who are on the Department of Employment Affairs and Social Protection's panel. Lists of dentists on the panel are available on welfare.ie. Most dentists are on the panel so you should not have any difficulty finding one. The dentist will be able to check your eligibility and make a claim for you. The claim form will require details such as your Personal Public Service Number (PPS number), date of birth and signature. If you are a dependent spouse or civil partner, you should give the PPS number of the insured person, who will also be required to sign the claim form.

http://www.welfare.ie/en/Pages/Treatment-Benefit1.aspx

k mac

Thanks turnipman I suppose what I'm wondering is because my cleaning was done by the hygienist and not the dentist would that make any difference

Turnipman

k mac wrote: »

Thanks turnipman I suppose what I'm wondering is because my cleaning was done by the hygienist and not the dentist would that make any difference

The procedure is what your PRSI is paying for, so it shouldn't really matter whether it was done by the dentist, the hygienist, the office cleaner or the receptionist! It appears as though you may have been overcharged for your first scaling and polishing (if that's all that was done to you) as the above info. cites a maximum extra charge of €15. It's certainly worth challenging, IMHO.

(Any further dental inspections and/or scaling & polishing in the same calendar year would have been payable by you in full.)

davo10

Kmac.

It does sound as if you were overcharged, but there is a possibility that you may not have been eligible.

A new internet based approval system was introduced to check approval for treatment at the same time as the cleaning was reintroduced in November. To say the social welfare site has problems is an understatement, when you attend, the Clinic inputs your PPS number and DOB, then a couple of seconds later the Dept either confirms you are approved for treatment or not. It regularly gives the wrong info.

If you contact the dental section in Dept of Social & family affairs in Letterkenny, they will tell you if you are eligible this year, if you are, they will just update their system and the dentist can put it trough & give you a refund.

Incidentally, the info above about max charge of €15 is only partly correct, that fee only applies to a scale and polish which is a light clean of calculus/staining on the tops of your teeth, usually this is a 10-15 min job. If you require plaque removal from under the gum line or if there are pockets between teeth, (what Hygienists do), then the fee is whatever the Clinic charges a private patient less €42.

9935452

k mac wrote: »

Thanks turnipman I suppose what I'm wondering is because my cleaning was done by the hygienist and not the dentist would that make any difference

I had cleaning done by a hygenist a few in may which was covered