DENTAL CLAIMS
Impacted Wisdoms
If you or your child is one of many people with impacted wisdom teeth that need to be removed in hospital, we feel for you. However, while it may not be the most pleasant experience, OMSMAF is here to help you through it – along with a healthy dose of ice cream and jelly, we hope to soothe that post-op pain.
To ensure that you do not encounter any surprises along the way, please be aware that Members on the Savings, Traditional (including SELECT), and Traditional Plus plans will incur a R1500 co-payment that needs to be paid to the hospital when you are admitted. It is also helpful to know that your Dentist/Maxillo-Facial Surgeon fee will be paid from your available Day-to-Day/PMSA benefits, while the Anaesthetist and hospital accounts will be paid at 100% of the Medical Scheme Rate from your Risk (or in-hospital) benefits.
If you have a gap cover policy, you may be able to claim your co-payment as well as any shortfalls on the Anaesthetist’s bill back from them. Remember to check with your Gap Cover Provider about this.
Members on the Hospital and Network (including SELECT) plans should please be aware that this benefit is limited to Prescribed Minimum Benefit admissions only.
Any dental quotes for hospital admission can also be sent to dental@omsmaf.co.za together with the information needed for the pre-authorisation, including the surgeon’s practice number, the hospital’s practice number, ICD 10 code/codes, reason for admission, procedure codes, and date of admission.
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