People are often surprised by their medical bill after treatment, as they were not fully aware of what their insurance company was willing to pay.
By the time Maria Dillenheim had her tooth filled and polished, there was not much that could be done. Her bill came down to more than D600, and her insurance company would only cover the consultation costs.
The reason, according to the insurance company, was that it concerned a failure treatment; a treatment that had been carried out before by another dentist, but was not carried out satisfactorily. In such case, the patient is required to pay for the full treatment.
"I had never heard of such a rule," tells Maria. "I was not prepared to pay this bill at all."
What was a surprise to Maria is not a surprise to experts in the field. Insurance policies are complicated, and in order to fully understand what you sign for some homework is required at the very least.
"If you want to be aware of all issues and exceptions you need to ask specific questions," advises the team of InsureMe.ae, an insurance platform in the UAE where end users can compare and select the most suitable insurance.
"In order to avoid confusion the client should understand what treatments are important for him or her and verify if these treatments would be covered. Patients should also ask where co-Insurance or exclusion or excess applies."
Dental insurance is for many clients a policy difficult to understand, and one of the fields where many surprises arise. "I have a dental policy with 30% co-pay. This led me to assume that I could opt for braces, but this turned out not to be covered by my insurance company," tells S. Kumar.
The reason why dental insurance coverage may lead to confusion is because dental insurance is an additional benefit under insurance policies, comments the InsureMe team.
"There are no standard dental benefit terms. Benefits can therefore vary from one provider to another provider.
"However, as a general observation it can be said that insurance companies distinguish between emergency, routine, major and orthodontic treatment," explains the team. "The term I.E. 'routine' and 'major' may be defined differently by each insurer and each insurer applies different sub-limits (the maximum amount they pay for dental).
In case of a failure treatment this should be clearly reported to the insurance company or the authorities, comments the team. "If your insurance company confirms on the phone that additional treatment for the same is covered you should note the full name of the person. If possible follow up with an email to summarize the conversation. This way you have a proof which you can produce later if the insurance company disagrees."
"It is important to note that since there is no standard or standard terms used it is often very difficult to understand the policy quickly. You will need to read the fine print to be 100% sure. Ask the broker for clarifications," advises the team.
But to be fully aware and informed about insurance coverage can be a time consuming effort, admits the team. "Good policy terms have color coded exclusions clauses so it is easier to track and read them. However, reading all plans and policies is extremely time consuming. If you have a trusted broker or insurance consultant you should address what is important to you or any concerns you might have."
Good Policy terms have color coded exclusions clauses so it is easier to track and read them. However, reading all plans and policies is extremely time consuming. If you have a trusted Broker or Insurance Consultant you should address what is important to you or any concerns you might have.
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