Cross Border Directive and Wisdom Teeth Extraction

Amik

All four of my daughter's wisdom teeth need extraction.

We'd rather do the procedures in an EU country we frequently visit. It's much cheaper and we can get it done faster.

Can we avail of the Cross Border Directive? Do we just need a referral from a regular GP or dentist?

Charles Babbage

Are you receiving public dental treatment in Ireland? The Cross Border directive requires the HSE to approve the cost.

Amik

Thanks Charles!

No, the daughter is 17 and we don't have a medical card. The only contact we've had with the HSE were school dental visits in the far past.

The wisdom teeth are bugging her already (all completely sideways) and would need to be surgically removed. I had similar so she won the genetic lottery. :)

We can only use public if we're medical card owners?

Dav010

Why don’t you get your daughter private health insurance (not private dental insurance, impacted third molar removal is considered a medical rather than dental procedure)?

Apart from the initial consultation fee with a private oral surgeon, the policy will cover the cost of impacted wisdom tooth removal. It will certainly be less expensive to take out private health insurance than it would for your daughter/parent(s) to travel to another country for treatment, and be a lot less traumatic if she can go to her home afterwards, and see the OS if there are any post op complications.

Charles Babbage

https://www.boards.ie/discussion/comment/120888277#Comment_120888277

I very much doubt if you can take out new insurance for an existing condition or at least not in good faith.

Dav010

https://www.boards.ie/discussion/comment/120888794#Comment_120888794

Considering the impaction has existed since the third molar teeth began to development, and the regularity with which teenagers tend to have symptoms when the wisdom teeth begin to erupt at 16/17, you must wonder how those who take out private health insurance after those symptoms begin are able to use that insurance to have them removed.

Peregrinus

https://www.boards.ie/discussion/comment/120889011#Comment_120889011

In general this is covered with a waiting period — you can't claim for treatment for a pre-existing medical condition (i.e. one that alreadyu existed when you took out the policy) until a stated waiting period has expired. The waiting period might be twelve months or 2 years or 5 years, depending on the condition and the age of the policyholder. You'd need to research the waiting period with different insurers for pre-existing impacted third molars would be.

Dav010

https://www.boards.ie/discussion/comment/120889019#Comment_120889019

Impaction is a qualifying condition for the procedure being covered (see attached form), if the third molar is not in fact impacted/pre existing, it is excluded. I’ll check waiting times when I get back to my clinic in a few days, that is between the member and the insurer, for approval purposes we report the date on which the referral is sent and date of attendance, if the patient intends using their private health insurance to cover their costs, it is almost inevitable that those two dates succeed the commencement of the policy. It must also be borne in mind that if the op were to travel abroad to avail of cross border treatments, there would also be an inevitable waiting period before treatment would be carried out.

https://www.irishlifehealth.ie/IrishLifeHealth/media/Irish-life-Health/pdfs/schedule-of-benefits/2018/SOB%202018/ILH_SOB_Dental_OCT2018_v3.pdf

Peregrinus

I think what amounts to a pre-existing condition is the subject of frequent disputes between insurers and insured. I suspect that if the date the referral is sent is very shortly after the commencement of the policy, the insurer will presume that the policy was taken out because the insured knew that the referral was about to be sent, and that is precisely the kind of thing that the pre-existing condition rule is supposed to guard against.

Policies will typically have a term which says something to the effect that, if there were signs or symptoms of the condition within the six months before you effected the policy, that's a pre-existing condition. Thus the relevant date is not the date on which the patient was referred to a specialist, or even the date on which a generalist diagnosed the condition, but the date on which the patient first experienced any signs or symptoms of the condition to be treated — which will, typically, be a date before they seek any medical advice about it.

For something like impacted wisdom teeth, it's possible that the patient won't have been aware of any signs or symptoms, but the issue gets diagnosed on a routine checkup. In that case I think the date of the checkup is the relevant date; if you take out a policy after that date, the impacted wisdom teeth are a pre-existing condition.

The bottom line, I think, is that if you already know you have impacted wisdom teeth that require treatment in the near term, it's too late to take out a policy; the existing condition rule will exclude you. But if a condition is a gradually developing one for which treatment can be deferred until after the waiting period has expired, then it's not too late. To make a decision about that you need to know what the applicable waiting period will be.

zell12

Yes. If it is publicly available in Ireland, then you can get treated in any EU country. Search the lists for 'dental extractions'

You need to be referred by a medic here and it needs to be authorised in advance by HSE

Dav010

https://www.boards.ie/discussion/comment/120889037#Comment_120889037

I’m sorry, you are incorrect.

The impaction of wisdom teeth is not the condition which necessitates their removal, many people go throughout life without symptoms associated with impacted wisdom teeth. In the vast majority of cases it is the acute bacterial infection, most often opportunistic, that causes the patient to seek their removal. The existing impaction is actually a condition of qualifying for benefit, not a hindrance to it. Also, the existence of wisdom teeth at a check up is not a diagnosis unless a problem exists with them, it is an observation to be noted along with all other teeth present.

Peregrinus

https://www.boards.ie/discussion/comment/120889137#Comment_120889137

Fair enough. So would it be fair to say something like this?

1. Case 1: You have impacted wisdom teeth and signs/symptoms of a bacterial infection which will necessitate extraction. If you take out health insurance now this will be a pre-existing condition and you will be denied cover for procedures undertaken during the waiting period.
2. Case 2: You have impacted wisdom teeth but no signs/symptoms of infection. You can take out an insurance policy now and, if you later develop an infection that requires removal, you'll be covered.

If that's correct, then it raises some further questions. Suppose I am diagnosed as having impacted wisdom teeth but, as yet, they are not causing a problem. I take out insurance. Can I now seek to have them removed, pre-emptively, so as to forestall infection, or is that something that a surgeon would decline to do, on the basis that there is no medical need for treatment? And — you may not know the answer to this one — if the surgeon does agree to treatment, will a health insurer pay for it or will they refuse on the grounds, once again, that pre-emptive removal of currently uninfected teeth is not medically required?

Dav010

https://www.boards.ie/discussion/comment/120889217#Comment_120889217

I'll answer the second part first. You can elect to have impacted wisdom teeth removed in the absence of symptoms, an example of where this may be necessary or advised may be as part of an orthodontic treatment plan or due to food impaction between the third and second molar, and yes, the fact that they are impacted qualifies the procedure for benefit.

In relation to the first part of your question, as I explained, pericoronitis (infection in soft tissues overlying the third molar) is the most common cause for people having their third molars removed. This can occur sporadically and is an opportunistic infection, most often happening when patients are run down or after another illness when immune response may be slow. Typically this can be cleared quite quickly with a course of antibiotics. Dentists do not tend to advise people to have their third molars removed the first time they are symptomatic, if they did, a high percentage of teenagers would having them extracted, this simply is not the case, and yet Insurers cover their removal once the necessary information is supplied for approval, such as an x-ray confirming impaction.