Need some advise cause my health insurance won't uphold their 75% coverage

Hi guys,

So I went in today to get my deep cleaning done. The procedure 2 quadrants of cleaning which is my lower jaw and splinting my front tooth. However upon paying, I was told that they would only cover 1 quadrant of deep cleaning (item 222 - root planning) and the splinting. So I have to fork out the entire 2nd quadrant which is 450 by myself. I called up by insurance, GMHBA, and they explained that under their policy they only cover 1 quadrant per day which is 6 teeth.

I find it ridiculous as no way in my care package was this mentioned and I have called them before and they have not mentioned that to me either. When I made this argument, they said that yes the information was not on their care package due to the fact that dental claim can have a long list of items and would be too much to print out. Also there are more than 6 teeth in a quadrant. I tried to speak with their supervisor and was put on hold for some time before I was hung up on!

I'm just wondering what can I do at this point to not have to pay the extra cost I forked over? If I had known about this then I wouldn't have gotten it done all at once today. I know for a fact that I would case them up tomorrow again regarding this issue. Any advice would be much appreciated!

Comments

  • Hi,
    GMHBA will probably say you can always phone and check before…
    Anyway, I'd suggest you contact: http://www.ombudsman.gov.au/about/private-health-insurance

  • +1

    A common trap with minor insurers…

    With any health insurance, always get the item numbers first and then call the insurer to check coverage BEFORE going to the practice.

    Having said that, I think what they are saying is ridiculous so do chase it up and if necessary, ombudsman should be involved.

  • Thanks heaps guys I will have to chase this up on Monday

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