Will our health insurance cover surgical removal of child’s wisdom teeth?

Q My son is having major issues with impacted wisdom teeth and will need to get them surgically removed. We don’t have dental insurance but we have private health insurance. Will our health insurance cover the cost of the surgical removal of wisdom teeth? Gerry, Co Tipperary

A The costs your health insurance plan will cover very much depends on the type of policy you have as cover can be quite varied. Wisdom tooth removal is either carried out by a dentist or surgically removed in a hospital – it is up to the dentist to decide which is the best option. Some general dentists will tackle impacted wisdom teeth, but most won’t.

When going for any procedure, I would always recommend seeking pre-approval from your health insurance provider. There are three pieces of information you will need to check with your provider. These are: the name of the consultant that will be carrying out the procedure, the procedure code (a code typically used to identify surgical or medical procedures), and the name of the hospital you are attending.

There are several procedure codes for the removal of wisdom teeth, depending on the position and if they are impacted.

Most level 2 plans – which are plans which cover semi-private rooms in private hospitals – will cover all private hospitals but in recent years, certain plans exclude some private hospitals so it’s essential to ensure you are covered for the hospital before the visit. 

Cover for HRT or visits to a menopause clinic

Q Do any of the private health insurers offer cover for Hormone Replacement Therapy – or visits to a menopause clinic, such as The Menopause Hub? I’m in my Forties now and would like to get onto a health insurance plan that offers good cover around the menopause – should I need it. Would you recommend any plans? Niamh, Co Cork

A There are no health insurance plans designed specifically for menopause. The Menopause Hub is run by a multidisciplinary team of consultants, psychologists, physiotherapists and dieticians. Many corporate plans will contribute towards the cost of these visits if they are listed as a participating consultant with your provider.

In the last 12 months, menopause cover is something which providers have introduced on their plans. Irish Life Health for example launched a new suite of ‘Health Guide’ plans. There are four options in this suite and these plans include benefits towards menopause – with each ranging in price and benefits to suit different budgets.

Laya Healthcare added menopause cover to some of its high-end plans in January and is due to extend this to several of its policies from July 1.

Cover for convalescence care

Q My mother had a bad fall recently and has spent the last couple of weeks in hospital. The hospital has advised that she may need to spend a couple of months in convalescence care before she can return home. My mother is on VHI Health Plus Access plan. Does this plan cover convalescence care – if so, how much convalescence care is covered? The hospital has also advised that my mother will need some home help whenever she returns home – assuming she can return home. Does the VHI Health Plus Access plan offer any cover for home help or for support provided in the home? Colin, Dublin City

A Convalescence is a minimum benefit so legally, all three of Ireland’s health insurers must include a certain level of this cover on every policy. Unfortunately, the cover offered is often limited and isn’t extended past 14 days. ‘Health Plus Access’ offers €51 per night for the first 14 nights towards the cost of semi-private or private room accommodation. Even VHI’s top plan ‘Premium Care’, which is €4,000 per person per year, will only cover €70 a night for the first 14 nights. There is a plethora of approved convalescence centres and these can be found on the VHI website.

VHI has a fantastic ‘Hospital@home’ service, which is covered on HealthPlus Access. When referred by a GP or consultant with one of the eligible conditions, the team will visit and assess your mother’s needs. All necessary medication and equipment are provided and she would be seen by a member of the team at least once a day and up to a maximum of three times a day.

Maternity cover on new plan

Q Seven months ago, I moved back to Ireland from a stint living abroad and took out health insurance immediately upon returning. I found out last month that I am pregnant. I had planned to wait until I was on the policy for the required 52 weeks before falling pregnant as I wanted to be treated privately. What’s the difference between public and private care and can I pay for private care without having served my waiting period for maternity cover? Gillian, Co Galway

A There is a 52-week waiting period for maternity benefit. The good news is, as you will have been insured for 52 consecutive weeks at the time you give birth, you will be covered for the maternity benefits listed on your plan. You don’t need to be on the policy for 52 weeks before you conceive.

There are three care path options available for maternity in Ireland – public, semi-private and private.

Your care is fully funded by the State if you choose to be treated publicly – as long as you are an ordinary resident of Ireland. You will be in a public ward and won’t pay for GP visits, ultrasounds, obstetrician appointments or delivery costs. Public care typically leads to a midwife-led birth but if there are any complications there is access to an obstetrician. The wait times for public care in Ireland are longer than for private – and you will receive fewer scans. Depending on your health insurance plan type, you may get a contribution towards some pre- and postnatal benefits.

Semi-private care means you will see your consultant or a member of their team at every visit and it often means less waiting time than public care. If your plan includes this type of care, your provider will cover the cost of the semi-private room, which is €813 per night. There are no plans that will fully cover the cost of semi-private maternity consultant fees, and these can be anywhere from €900 to €3,000. You will pay these fees, but all other expenses will be charged to your health insurance provider. Some plans give a contribution towards these consultant fees and other pre- and post-natal benefits.

Private care allows you to see the same private consultant during pregnancy and will often give increased scans and visits. You select the obstetrician, and they are typically present at the birth. Plans will cover the cost of a private room (which is €1,000 per night) and some plans may give a contribution towards consultant fees, which are typically between €2,000 and €5,000 for private care. Private consultants do not usually accept patients without health insurance.

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