No payment after approval
<p>Email by my husband: On the 12th of October I went to the dentist and asked him for a quotation for work to be done on my teeth. I received the quotation and sent it to Denis. On the 27th of October I received your approval - you told me that you are only going to pay R 8 277.22 and I am responsible for R 10 490.00 of the total of R 18 767.80.</p> <p>I told the dentist to carry on with the procedure, I am willing to pay my portion.</p> <p>I was then told that I am responsible to pay the laboratory before they will release the bridge to the Dr. I paid the laboratory R 5 838.03.</p> <p>After the bridge was installed I paid the Dr. R 4 961.00 for his portion of the work. (In other words I have already paid R 10 799.03 – R 308.45 more than what I was told my portion would be). This morning I received a statement from you wherein you rejected another portion of what the Dr. has claimed.</p> <p>I had an appointment with Dr. Louw this morning - he had to carry on with the procedure for the Flexi-denture that was also part of the quotation, but stopped it because according to him I will have to pay the laboratory again and his portion of the work as well. In other words I will end up paying the whole amount of R 18 767.80 and your office keep on rejecting more and more of the items the Dr. is claiming.</p> <p>Unfortunately I had a similar bad experience with Denis in the past where they just refused to pay after the work was done.</p> <p>In this case I followed the right procedures and are not going to be taken for a ride again and therefore I am going to give this whole issue over to my Attorney to handle.</p> <p> </p>
Good day Celia
We confirm that we have received and are investigating your query. A service consultant will be in contact with you within 48 hours.
Best regards,
Good day Celia
We confirm that we have received and are investigating your query. A service consultant will be in contact with you within 48 hours.
Best regards,
Good day Celia
As discussed telephonically, only the dentist account was received, not the laboratory account. Hence only the dentist account was paid.
We contacted the laboratory this morning to advise and shortly thereafter received their account. This has been sent for processing and once finalised payment, in accordance with registered scheme rules and managed care protocols, will be generated to the member.
A detailed Denis remittance advice will be forwarded to the member once the claim and payment process is complete.
Best regards,
Good day Celia
As discussed telephonically, only the dentist account was received, not the laboratory account. Hence only the dentist account was paid.
We contacted the laboratory this morning to advise and shortly thereafter received their account. This has been sent for processing and once finalised payment, in accordance with registered scheme rules and managed care protocols, will be generated to the member.
A detailed Denis remittance advice will be forwarded to the member once the claim and payment process is complete.
Best regards,
I think there is still a lot to be sorted out. My husband now has a hole in his mouth where the implant approved together with the bridge should have been and with which the dentist stopped because of non-payment after my husband had already paid more than his share according to the quote. Maybe DENIS should teach the dentists how to submit their accounts because you have been unhappy with something on every single account we have submitted the past 3 years. And we are sick and tired of struggling with DENIS while actually being Medihelp patients and paying Medihelp premiums which supposedly include dental care that we don't get unless we pay the bigger portion of all bills.
I think there is still a lot to be sorted out. My husband now has a hole in his mouth where the implant approved together with the bridge should have been and with which the dentist stopped because of non-payment after my husband had already paid more than his share according to the quote. Maybe DENIS should teach the dentists how to submit their accounts because you have been unhappy with something on every single account we have submitted the past 3 years. And we are sick and tired of struggling with DENIS while actually being Medihelp patients and paying Medihelp premiums which supposedly include dental care that we don't get unless we pay the bigger portion of all bills.
Good afternoon
We confirm that authorisation was granted for a three unit bridge and a one tooth partial denture. Benefits for implants were not approved as these benefits do not form part of the benefit structure on your chosen option. The dentist account has been processed and paid, the laboratory account is being processed and will be paid with our following payrun.
Denis does in no way dispute or question the type of treatment which was requested/performed. All benefits are confirmed within the framework of the managed care protocols and registered scheme rules.
In the event that the treatment is charged above the scheme tariff, benefit exclusions or where a co-payment applies, the member is liable for the shortfall of the claim.
We thank you for the feedback provided to us.
Best regards,
Good afternoon
We confirm that authorisation was granted for a three unit bridge and a one tooth partial denture. Benefits for implants were not approved as these benefits do not form part of the benefit structure on your chosen option. The dentist account has been processed and paid, the laboratory account is being processed and will be paid with our following payrun.
Denis does in no way dispute or question the type of treatment which was requested/performed. All benefits are confirmed within the framework of the managed care protocols and registered scheme rules.
In the event that the treatment is charged above the scheme tariff, benefit exclusions or where a co-payment applies, the member is liable for the shortfall of the claim.
We thank you for the feedback provided to us.
Best regards,