Bupa Said I’m Not Covered for Dental after Upgrade

Have Bupa Gold and just informed I’m not covered for 2 teeth extractions tomorrow. Well will get $150 rebate off $900 Bill.
My cover shows I have $$$$ left this year for general and also $$$$ for major dental. As it’s the weekend can’t talk to anyone at Bupa (ridiculous).

I just want to know what category extractions come under?

Wish I could cancel everything including changing Health Funds. I’m not rich. Anyone know why I’m not covered?


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  • Bupa Gold what?

    There are several Bupa golds

  • Is it a day procedure or are you having them out in the chair? If it’s the former you have your answer why.

  • Need more information including the full name of your cover and how long your have held it. If you have recently changed your level of cover that can make a difference too.

  • Day procedure in Hospital. I have crowns over the teeth.
    I’m covered for being in hospital with no excess.

    • Dental covers any done done by a dentist. A surgical extraction is done by an oral surgeon. This is not general or major dental according to private health insurance.

      What you’ve quoted is in line for what you can expect to get back.

      • The dental portion will most likely be bill under item number 324 - Surgical removal of a tooth or tooth fragment requiring both removal of bone and tooth division. This falls under general dental. Surgical extractions can be done by any dentist as long as it's within the scope of their training and skill.

    • Is it too late to cancel? Bupa is opened tomorrow but unlikely to be covered.

  • All I can see on my policy is Gold Hospital with your choice Extras 60.
    The specialist dentist said it would be cheaper to have it done in hospital.

    • +6

      Don't rely on the doctor ever.

      Before you commit ask for a quote, item numbers and which hospital.

      Call your private health insurance with these details to calculate your out of pocket. Simples.

    • Yeah, like others have said don't rely on your doctors or health professionals when it comes to quotes. Always call your provider and get it in writing. Definitely don't have your quote done at a store or kiosk if you're not coming away with any paperwork. I made that mistake a while ago and it ended up costing me big time. The ombudsman said to never do quotes at the store as there are no records of exactly what was said and because it it's a case of he said, she said, there is nothing they can do to help you if you ever get into trouble. When you do it over the phone they can pull your call from their records.

  • I’m so upset if this is the case. Rang my Oral Surgeon yesterday and the day before. Didn’t get back to me. Think I won’t turn up at the hospital and put up with the pain until next year. That’s how I feel.

    • +8

      Hospitals might charge a non-attendence/no show fee or a late cancellation fee. Honestly get the procedure done if it's causing you pain. $750 for 2 extractions is not bad and it's not worth being stingy with health costs.

      I know someone who refused to pay to see a dentist for minor dental problems and now is footing a massive bill for major dental issues.

    • $750 for no pain for a couple months. I know what I'd do.

    • +7

      You didn't do your due diligence. You didn't ask for a quote, didn't contact Bupa to ask how much they would cover, but merely assumed it would be more than $150. Now you're thinking about pulling a no show and wasting someone's time. That's extremely unprofessional and rude.

  • OP, how far in advance did you book for this appointment? Either this was an emergency procedure or you left it late to check you gap payments. Either way you have limited options now.

  • +1

    Wish I could cancel everything including changing Health Funds.

    It's never a good idea to be in a for-profit health fund.

  • Considering that Medibank is so shit that 1 tooth extraction still cost $340 after $160 rebate in a chair. You would count yourself lucky.

    Really at the end of the day, it's not Bupa that's not covering you, most private insurance won't cover you. At least with Bupa, in my case, the service reps are knowledgeable and helpful compared to Medibank who will throwing you promotions at stores that are overpriced, small range and understocked and their service rep will waive your waiting period but bump up your excess without telling you and can't tell you the difference between annual claim limit and lifetime claim limit followed by telling you the wrong one. The last part cost me over 4k last year.

  • +2

    The reason you're not getting the full amount covered is because that's how extras cover works. They will only rebate a certain amount or percentage of the procedure. There are some procedures that the health fund will provide a full rebate for but they're usually the exception (and even then there are conditions imposed like it must be provided by a preferred provider).

    • wouldn't this be covered under hospital if done under general? assuming by a maxfax surgeon

      • No, because extractions are classified as a dental procedure and paid out under the dental schedule which is under extras cover and not hospital.

  • The BUPA triple platinum or whatever, at least $100 per month per family member, covers more and more often for extras. Sometimes the rebate on any service almost pays the whole thing. BUPA probably can’t negotiate good rates on dental though, dentists have their own guild thing going on which is its own institution seperate from standard medical school. Dental school isn’t cheap so no dentist wants to start seeing dental being a common thing that any person can afford to access. You don’t pay off dental school and then start buying nice things, all whilst staring into rotten mouths all day for decades, and then feel like start giving away your time to BUPA or the government or anyone else for less money so it takes even more decades to pay off school and buy those nice things. The money is literally the only good thing about being a dentist, other than having some fascination with oral medicine anyway.

    • Nice rant. I can see you have strong feelings about dentistry.

      • +1

        Oooo don’t even get me started on whether it’s the state or federal responsibility to pay for universal dental if he had universal dental.

  • Paying for private health insurance and expecting them to actually cover something.

    That's where you went wrong. I've never been able to make the maths for private health work.

    • You need lots of kids. They’re no extra charge and you can claim a lot of things for them.

      • +1

        I have but two, as a responsible human being.

  • +1

    Hopefully a wake up to just budget what you pay in private health cover towards a health costs savings account for yourself instead.

  • I have been with Bupa before that same Company MBF - about 42 years. Obviously teeth extractions aren’t covered under general or major dentistry? My oral surgeon wouldn’t reply to my calls before surgery but yesterday he said he heard I was trying to contact him. His staff kept saying he’s a very busy man. Felt like saying, yes and without his patients he wouldn’t be busy. I feel terrible today after surgery, not physically but mentally. Think it may have been cheaper to go to public dental hospital as still on disability pension. Pain I can handle not financial pain. Anyway that’s my beef for today. Thanks all for your input.

    • My guess is you’ll find another oral surgeon next should you be unfortunate enough to require future work done.

    • I just realised that no one has answered your original question, extractions fall under general dental. It's not that you're not covered but rather the rebate of the procedure is only a percentage or set amount and not the full amount. Very few procedures attract a full rebate, especially if they're not a preferred provider.
      If you hold a concession card/health care card treatment through the public system would've been cheaper as the co-pay is usually capped (in VIC it's capped based on general or specialist care). The down side is the waitlist and the lack of choice to who your practitioner is.

      I'm sorry to hear that the communication between you and your surgeon has left you unhappy. I hope you a have a smooth recovery.

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