Essential Med Complaint

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SUPPLIER	Essential Med	INDUSTRY	Insurance
BRANCH / AREA	Cape Town	COUNTRY	South Africa
TIME / DATE	15:17 Mon 24 Oct	PERSON RESPONSIBLE	Authorisation
CUSTOMER	Caroluta	View all reports by user	0 1
PROBLEM	Not Authorising treatment	Post this report to your Facebook page Post this report to your Twitter page
INCIDENT	Mon 24 Oct
HEADLINE	Dental treatment for my son
My son is 4 years old and needs Dental treatment. Root canals and extractions. The dentist that we see needs him to go into theatre for this because of his age. Her concern is that because he is 4 years old his body will not react well to conscious sedation in the dentist chair and the length of time he will be under. Approx 1.5 - 2hrs. It has been reported that children have passed away because of the length of time under conscious sedation. I contact Essen Med to obtain a auth number and they declined his Dental procedure. I was told he is old enough to conscious sedation. My dentist wrote a motivation to Essen Med explaining that keeping him in the Dental chair is dangerous. Still it was declined. The lady that assisted me was very professional and helpful, i cannot complain about that. I have not had a problem with Ess Med covering any other Dental work. I am so dissapointed that they will not cover this. But let me ask this. Would they take the chance of Conscious Sedation with their child? I most definitely wont. Now what am i to do? My son is in pain now and is not covered. I am concerned now about my other children, what if the are in a accident? Will they be covered? Add a new Essential Med Report Inappropriate report?
SUPPLIER'S RESPONSE	Essential Med	Time and Date	17:53:25 \| Tue 25 Oct 11
Hello Caroluta, Thank you for your ongoing support and compliments with regard to our service to date - we greatly value your feedback. Although we can understand your situation, our policy benefits unfortunately do not extend to covering the costs of the procedures requested on the basis of a full sedation via anaesthetist in an operating theatre. Our stated benefits include your basic dentistry needs (cleaning, pain control, fillings and extractions), as well as emergency root canals and the extraction of wisdom teeth, provided that these procedures are conducted in the dentist's surgery under local anaesthetic. Full and semi-sedations are unfortunately not covered under our policy benefits as stated in our policy schedule and on our website. Please note that your policy benefits make provision for 2 'clean and polishes' per year and we would encourage all clients to make use of this benefit to avoid the need for specialised dentistry. We regret that we are unable to assist you in this specific instance, but assure you of our continued good service and firm commitment to delivering on our stated policy benefits at all times. Kind regards Lee Rodgers Chief Operating Officer