Health Insurance VHI - PMI 42 15 - Teeth Whitening

Páid

Registered User
Messages
703
I'm in dispute with the VHI over a claim I made last week.

My plan is PMI 42 15 and as the Table of Benefits states I am entitled to 12 visits per year to a dental practitioner.

I visited a dental practitioner last week for the first visit of two in order to have teeth whitening moulds made at a cost of nearly €200. VHI rejected the claim stating that the treatment is not covered. I argued that the Table of Benefits states that I am entitled to 12 visits and it doesn't mention anything about eligible or ineligible treatments. When I called them the first time I asked the person I spoke with for a list of eligible / ineligible treatments and they said that there is no such list.

Am I covered or not?

pmi4215.png
 

Ceist Beag

Registered User
Messages
1,317
In your claim, did you put it in as a dental visit, or a dental treatment? If the former I would have expected it to be covered alright (for €40 not for the full €200 obviously). Is there anything in the terms and conditions that lists exceptions to this cover?
 

Kimmagegirl

Registered User
Messages
287
I wouldn't expect teeth whitening to be covered
Maybe not, but the health insurers need to clarify what is and isn't available. I have a Laya policy that says in one section that the Beacon Hospital is "fully covered" and in another it says it is subject to an excess.
 

Ceist Beag

Registered User
Messages
1,317
I wouldn't expect teeth whitening to be covered
It all depends on what the OP was claiming. If claiming for teeth whitening then you're correct. However if claiming it as a dental visit (and just claiming the €40, not €200) then why would that not be covered?
 

Páid

Registered User
Messages
703
I'm just claiming the €40.

The heading on that section in the Table of Benefits is;

Section 9 – Day-to-day medical expenses (benefits are per visit, per member, unless otherwise indicated)
G Dental practitioner - 12 visits €40

There is nothing else indicated under dental, for example - that there are eligible or ineligible treatments or that teeth whitening isn't covered.

I have asked them twice for a list of eligible treatments and they have refused to provide it.

My argument is that that the table of benefits makes no mention of treatment, only visits. If only some treatments are covered then that is a material fact and they have a duty to disclose it to me in advance. Fiduciary duties go both ways.
 

arbitron

Registered User
Messages
217
Teeth whitening is a purely cosmetic procedure so I would not expect any cover for it at all; however, their documentation is really vague and if they haven't excluded it then I think you should push them to honour what they have written.

I note that they also cover 75% of an unlimited number of visits to various charlatans, such as Acupuncturists, Chiropractors, Osteopaths, Reflexologists... Unbelievable BS which VHI should be ashamed of.
 
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