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Blog Series – All you wanted to know about health funds but were afraid to ask – Deciphering the item numbers – Part 3 – Item no.’s 811-999

April 15, 2019

At Seymour Dental we offer the convenience of being able to claim your Private Health Fund by swiping the card on our Hi-Caps machine and paying the balance. The difference to be paid depends on the level of cover of the patient. For some it can be 50%, 70% or even 85%. This is solely between the patient and the level they have chosen to be covered with the health fund. Each health fund has its own set of conditions, which are out of the control of the dentist.

Please keep in mind when using private health funds:

Some health funds don’t allow the card to be used after 24 hours, e.g. bringing the card in the next day.

Over the phone payments are not permitted by the health funds, unlike credit cards which can be done over the phone.

Level of cover depends on the private health fund.

Waiting periods of 12 months exist for extensive treatment items e.g. root canal therapy, crowns and bridges, veneers, implants, surgical procedures, orthodontics and bleaching. Some health fund levels don’t cover everything as well.

Two examinations and cleans are allowed a year every 6 months, however a second clean needed with some gum problems can be done every 3 months.

The patient has to be the one on the card treated, not permitted to use some else’s card.

Some health funds offer “Package Bonus Points”. This is a percentage paid/discount from health fund loyalty bonus points. The nurse will ask the patient if they would like to use them. Some patients save them for example, for medical operations. This means the bonus can be applied to the balance after rebate.

Health funds are great to have and help enormously; these are a few things to be aware of.

It’s important to find out eligibility and rebate amount before starting treatment. It’s advisable to get the person’s name, time of call and call centre location of the health fund operator, so if there is any dispute you can prove who gave you the information. This is important if a decision to proceed with a crown was based on the rebate and eligibility for such treatment. This has forced funds to pay the rebate that was stated either over the phone or at a health fund office.

Unfortunately, you need to do your homework!

Fixed palatal arch appliance - Item 841
Teeth with braces - item 881
Medication for sedation placed into the vein. Pulsimeter clipped on the thumb to monitor the pulse.
Occlusal splint on upper teeth
Sleep apnoea device on models

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