ACC and dental cover

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surfisup1000

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#240008 15-Aug-2018 09:14

Daughter had a sporting injury to her tooth requiring dental work.

Total cost of dental procedure is $2700, ACC covers about $800 (estimate as dentist can't actually say up front because of the convoluted system they have for dental).

I was surprised, I thought ACC would cover at least 80%.

HcoNmeM

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#2073702 15-Aug-2018 09:19

My mother in law got an implant paid for by ACC, she had to pay some but if you put a % on it.. maybe 10% she paid the rest ACC paid..

I'd check with them about that, unless policy etc has changed.

sbiddle

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#2073703 15-Aug-2018 09:28

I had an implant installed about 6 years ago as a result of a tooth I had knocked out when I was a kid. While ACC covered it (as they had covered the original accident), it was probably only around 70% - 80% of the total cost as the fixed fees ACC pay are significantly less than what dentists charge.

antoniosk

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#2073709 15-Aug-2018 09:37

surfisup1000:

Daughter had a sporting injury to her tooth requiring dental work.

Total cost of dental procedure is $2700, ACC covers about $800 (estimate as dentist can't actually say up front because of the convoluted system they have for dental).

I was surprised, I thought ACC would cover at least 80%.

I'd go back to acc and escalate that to a manager, something smells there.

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surfisup1000

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#2073798 15-Aug-2018 10:48

sbiddle:

I had an implant installed about 6 years ago as a result of a tooth I had knocked out when I was a kid. While ACC covered it (as they had covered the original accident), it was probably only around 70% - 80% of the total cost as the fixed fees ACC pay are significantly less than what dentists charge.

I too thought ACC might cover around 80%....but, the dentist explained ACC have a set refund amount for each procedure. Eg, xray, consultation, root canal, bleaching and so on.

For example, the bleach costs $550, but ACC only pays $182 of that.

I pay the total cost up front, approx $2700. The receptionist calculated I might get an $800 refund.

It means I will end up paying around $1900 for a $2700 procedure. This is for a front tooth and is quite important for a 13 yr old girl .

But, I don't know, maybe ACC will pay a bit more. I will post back here with the final amounts.. could be several months before ACC figures things out though.

sbiddle

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#2073799 15-Aug-2018 10:49

Really just shows how much above ACC determined true costs dentists really charge..

Geektastic

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#2073814 15-Aug-2018 11:10

sbiddle:

Really just shows how much above ACC determined true costs dentists really charge..

Or, I suppose, how out of date ACC's estimating is?

Hard to know which!

surfisup1000

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#2073825 15-Aug-2018 11:22

Geektastic:

sbiddle:

Really just shows how much above ACC determined true costs dentists really charge..

Or, I suppose, how out of date ACC's estimating is?

Hard to know which!

It will be interesting to see the final cost/refund.

Funny thing is, my daughter plays rugby 7's and netball, but of course this happened during netball. Dentist said netball dental injuries are fairly common and maybe netballers should wear mouthguards. At least she got MVP , makes it all worthwhile haha.

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sbiddle

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#2073841 15-Aug-2018 11:58

There is a document on the ACC website https://www.acc.co.nz/assets/provider/acc1522-costs-dentist.pdf

antoniosk

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#2073862 15-Aug-2018 12:55

sbiddle:

There is a document on the ACC website https://www.acc.co.nz/assets/provider/acc1522-costs-dentist.pdf

Document is nearly 2 years old now. Maybe they base their rates on dentists in gore... i havent seen rates like that in wellington since the mid 90's.

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Antoniosk

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#2075092 17-Aug-2018 23:42

sbiddle:
Really just shows how much above ACC determined true costs dentists really charge..

I've just been to the dentist, the hygienist was showing off the mouthguard the dentist had just made for her son. I asked him about typical % covered by ACC. He thought about 50%, mentioned that coverage was ongoing if there was future problems related to accident. A lot depended on how much the dentist charged (and maybe whether part of a franchise).

mattwnz

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#2075093 17-Aug-2018 23:52

Maybe you need to ask ACC which dentist is actually charging that as I would have thought information would need to be accurate and realistic. Maybe you could ask the dentist what they would charge if it didn't go through as an ACC claim, because maybe there is also more costs involved with paperwork? I know when I needed dental surgeon work, they had a cheaper price if I was paying cash and it wasn't a health insurance claim.

timmmay

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#2075107 18-Aug-2018 06:43

Those ACC costs are low, but perhaps if they have dentists under contract they accept that? I doubt it though.

I've found with ACC that if you're polite and reasonable, and ask reasonable questions, you will often get somewhere. If they won't budget and you can find policy or a rule that says they should you can take them to independent review, though be aware ACC controls that and you need a good cause and good evidence to win. I did get a favorable decision at independent review.

There is an independent, ACC funded advisory service that will give you advice on cover and how to approach ACC. I can't remember the name but Google might find it for you now you know it exists.

surfisup1000

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#2076226 20-Aug-2018 13:50

timmmay:

Those ACC costs are low, but perhaps if they have dentists under contract they accept that? I doubt it though.

I've found with ACC that if you're polite and reasonable, and ask reasonable questions, you will often get somewhere. If they won't budget and you can find policy or a rule that says they should you can take them to independent review, though be aware ACC controls that and you need a good cause and good evidence to win. I did get a favorable decision at independent review.

There is an independent, ACC funded advisory service that will give you advice on cover and how to approach ACC. I can't remember the name but Google might find it for you now you know it exists.

I'd imagine those prices are legally binding and it would be impractical to negotiate costs on a case by case basis.

Out of curiosity, I may ring that advisory service.

May send a letter to the ACC minister too, showing the breakdown of costs and what ACC pays. To show that there is a huge discrepancy -- if my daughter had torn an ACL she would get the $10,000 treatment for free, but because she damaged her mouth, we only get 1/3 costs covered.

It doesn't make sense to me. But, that is the problem with schemes like ACC, there are lots of things that make no sense at all.