DENIS
Application for proper dental care declined

My 11 year old daughter fell and a part of her incisor broke off and left her with an awful smile which is tempering with her esteem. An application for a crown was lodged with Denis and to my surprise it was rejected on the basis that the benefit for crowns and bridge treatment is limited to individuals 12 years and older. This is some shocking revelation given the fact that there is no scientific reason for the exclusion of persons younger than 12 years. Furthermore, this is not captured as a scheme exclusion under the Bonitas dental benefits 2013 (refer to page 3). According to the document and option benefit, 1 crown per family per year is covered at 80% of BDT, subject to managed care protocol. Based on the Bonitas dental benefits 2013, the decision to reject is unfounded because this is 1 crown and the first in 5 years that i have been with the scheme. I have requested a copy of the managed care protocol/rules to which the decision was made and the scheme failed to supply. This has left me wondering what else is excluded for my precious daughters who are both under the age of 12. I am extremely disappointed by Denis and will be seeking legal advice on the matter.

Company: DENIS
Country: South Africa
City: Bonitas

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