DENTAL BENEFITS AND PRE-AUTHORISATION :
What you need to know Did you know that there are Time Rules that apply to your dental benefits ? This means that if a claim was paid for a certain treatment , the applicable benefit might only be available again after a specified period . One example is the benefit for scaling and polishing ( code 8159 ) that for most Bonitas options is covered only once in 6 months , i . e ., the treatment dates should be 180 days or more apart . For the BonCap option , the benefit is one scaling or polishing per beneficiary , per year . These type of protocols and limitations are in place to ensure that your benefits are available for clinically appropriate treatment when you need it the most .
Before any treatment starts , ensure that the dental practice contacts DENIS on 0860 336 346 to confirm whether benefits are available for the specific codes applicable to the planned treatment . Keep in mind that if the practice is not part of the DENIS Dental Network , they might charge above the Bonitas Dental Tariff . The DENIS service consultant will generate a quote so that you know exactly what amounts are covered by Bonitas and what you will have to pay .
Dental authorisations The claims for some dental procedures * will only be considered for payment if authorisation is obtained before the treatment is done .
If your dentist plans a dental procedure that is subject to authorisation , ask the practice to contact DENIS . You can also phone 0860 336 346 or send an email *.
Each type of procedure has its own set of requirements for authorisation . To ensure that there is no unnecessary delay in the authorisation process , visit the DENIS website ( www . denis . co . za ) to find out if you have all the required information available .
Feedback will be provided to you telephonically or on an authorisation letter within six working days .
* Pre-authorisation is required for the following dental procedures / treatment
Dentures
• Plastic dentures
• Partial metal ( chrome cobalt ) frame dentures Email : customercare @ denis . co . za
Specialised dentistry
• Crown and bridge Email : crowns @ denis . co . za
• Implants Email : ortho @ denis . co . za
• Orthodontics Email : ortho @ denis . co . za
• Periodontics Email : perio @ denis . co . za
Moderate or deep sedation in the dental rooms
• Benefit limited to extensive dental treatment Email : hospitalenq @ denis . co . za
Hospitalisation / General anaesthetic
• Benefit available for children under the age of 5 years for extensive dental treatment and for the removal of impacted teeth Email : hospitalenq @ denis . co . za
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Bonitas Member Magazine Issue 3 | 2021