Dental benefit scheme

I had to get hard nightsplint from my dentist. According to department of Social & Family Affairs, this is covered under the dental benefit scheme where department pays half dentist fee and half lab fee. I received written confirmation of this albeit handwritten!! My dentist claims this is not covered under the scheme. Just wondering does anybody know whether it is covered or not?

Does this Welfare guide help at all?

thanks for reply - useful site I didn't know about. Unfortunately it does not seem to cover nightsplint.

My wife had a routine dental visit in early July. When leaving she expected to simply fill in the relevant form re PRSI but was caught off-guard when the receptionist asked for €80 and explained that the PRSI refund would be forwarded to her; she promptly wrote a cheque. I was highly suspect of this.

From what I can see on 'The Department pays the full cost of oral examination, scaling and polishing (including mild gum treatment).' Following ClubMan's link above would suggest that the cost of an oral exam & scaling should cost €59.55 not €80. Does any AMMer know if a DSFA panel dentist is entitled to charge over and above the DSFA amount for a routine visit?

Secondly and to no surprise, no cheque was forthcoming. My wife rang the dental surgery about two weeks ago re cheque and was told 'oh yes it's here, we'll put it in the post' . . 10 days later still no cheque and she rang again to be fed the same line but this time a cheque (signed by the dentist and for an odd amount €61.05) did arrive a day or two later. I suspect that many people do not follow up on the DSFA refund and this dentist pockets the initial charge and the refund.

Does this sound like the norm or is it just my wife's dentist?

patient needs to have approved prsi form (white in colour) to obtain prsi treatment period, and without this form there is no compulsion on a dentist to refund anything.

Does any AMMer know if a DSFA panel dentist is entitled to charge over and above the DSFA amount for a routine visit?

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yes if there is gum disease as this is a grant in aid item (code 051).

markowitzman, you sound like you know what your talking about here so can you tell me if a DSFA listed dentist can charge over and above the DSFA amount for a routine visit which only includes an oral examination 020 and prophylaxis 030? Are you suggesting that a dentist whom you have paid already is entitled to claim and keep the PRSI refund?

I guess, from reading your post, that it is the case that without the pre approved 'white' PRSI form the dentist can charge what they like and If one subsequently fills in the claim form then the dentist will/should refund same.

can you tell me if a DSFA listed dentist can charge over and above the DSFA amount for a routine visit which only includes an oral examination 020 and prophylaxis 030?

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the key question is whether the patient has gum disease or does not have an approved form. If they have approved form and no gum disease then no. If gum disease or no approved form then dentist can charge private which is non refundable. The only alternative at short notice to the white form is a fax from dsfa with the word approved after the patient name. Verbal assurances from dsfa that patient is approved are worthless in my experience.

without the pre approved 'white' PRSI form the dentist can charge what they like and If one subsequently fills in the claim form then the dentist will/should refund same.

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Yes to first part and No to second part, there is no legal compulsion on dentist to refund in this case. The onus is on the patient to verify approval prior to dental treatment although most practices will assist patients in this regard. It is important to note that dentist is a private dentist that will treat approved prsi patients. The phrase prsi or dsfca dentist therefore is a misnomer. Hope this helps.
Much of this discussion relates to patients that are new to a practice or lapsed or their circumstances have altered. We generally take a risk with 6 month regular patients and do not look for pre-approval although it still amazes me how often we are caught out by the department with non-payments for routine care for these patients.

Thanks for the reply markowitzman, you've cleared up my scooby doo mystery. I'll ensure that that my wife obtains DSFA pre-approval in future in order to avoid paying the private fee/DFSA grant mismatch. I can't help feeling that we would never have seen the refund cheque if we hadn't chased it.