1 reviews | Active since Feb 2016
Who decides what is severe
My issue started sometime in October 2015. my teeth started giving me issues so i went to a dentist who advised that my wisdoms needed to be removed , he explained that medical aid does not cover that , i was put on antibiotics as there was an infection which then cleared up .and all was well . this year again the same thing happened , i got another infection and i was advised that because my teeth were severely impacted they needed surgical removal, again in the interim i was given antibiotics which for a week or 2 helped then i was back to square 1. I made a few calls all of which were pleasant i was advised that only certain dentistry issues where covered in hospital (severe dentistry issues). The pain was getting worse so i decided to visit a dentist who would be willing to remove the wisdom surgically. I paid cash - a few xrays where done and he advised that i needed to remove all 4 of my wisdoms surgically and i also needed 2 root canals urgently all of which would amount to 12100 excluding medicine for pain in order to avoid constant infections . My question is then how severe do ones issues need to be in order to get assistance.
I investigated your concerns and as the administrator of the KeyCare Health Plan, with a membership base of over 320 000 members, we need to ensure the long-term sustainability and affordability of the health plan. This is done firstly by the KeyCare Income Verification process. The second is by managing benefits that members on the KeyCare series have access to.
In your post your main concern is what makes a condition severe to be considered to be funded. Certain maxillo-facial procedures will be covered however it is subject to a defined list of procedures with no deductibles and no overall limits.
Based on the information provided the criteria was not met to have the treatment covered. Unfortunately the funding decision will remain the same.
I am sorry that I could not provide you with a different outcome to your query.
Regards
Jashvir
I investigated your concerns and as the administrator of the KeyCare Health Plan, with a membership base of over 320 000 members, we need to ensure the long-term sustainability and affordability of the health plan. This is done firstly by the KeyCare Income Verification process. The second is by managing benefits that members on the KeyCare series have access to.
In your post your main concern is what makes a condition severe to be considered to be funded. Certain maxillo-facial procedures will be covered however it is subject to a defined list of procedures with no deductibles and no overall limits.
Based on the information provided the criteria was not met to have the treatment covered. Unfortunately the funding decision will remain the same.
I am sorry that I could not provide you with a different outcome to your query.
Regards
Jashvir