There are a number of reasons why your health insurer may not pay a benefit for your dental treatment. When we process the claim using our HICAPS terminal, a reason may be provided and we can provide you with information on how to resolve it with your health insurer. Sometimes a reason will not be provided, and you will need to contact your health insurer. We are not able to do this on your behalf as it is between you and your health fund.
When making claims via the HICAPS terminal, the most common reasons why your health insurer is not paying a benefit for your treatment includes;
|
Reason |
Explanation |
Next Steps |
|
Limit Reached |
You have reached the annual benefit limits on your policy |
You will need to pay for your treatment out-of-pocket |
|
Waiting Period |
You have not completed the waiting period |
You will need to pay for your treatment out-of-pocket |
|
Refer to Fund |
There may be an outstanding issue or other reason |
Please contact your health insurer |
|
Membership Un-financial |
Your policy premiums have not been paid / are not up to date |
Please contact your health insurer. It's possible the scheduled payment bounced due to expired credit card or insufficient funds in your account |
|
No Ancillary cover |
Dental cover is not included in your health insurance policy |
You will need to pay for your treatment out-of-pocket |
|
System Problem |
There is a problem with the health insurer's systems and we are unable to communicate and claim directly at this time |
You will need to pay for your treatment out-of-pocket and claim directly from the health insurer at a later date. For treatments under our No Gaps policy, a refund may be available. |