Hi, I have a question concerning ongoing dental treatment from an historic accident of a child and I hope someone can help as we are just getting shunted between insurance companies. I apologise in advance for the long read!



Brief backgound
In May 2006 when my daughter was 8 she had an accident that resulted in her requiring dental treatment for gums and teeth. We had normal health insurance and an additional dental insurance. Both with the same provider. She had ongoing treatment over a number of years with the dentist and at Basel hospital until it reached the point where they stabilised her front teeth and said that further treatment would be required once she reached adulthood and her jaw stopped growing. Until that point the insurance company had covered all the treatment related to the accident.


Siutation now
Now both the dentist and hospital are saying it is time to have further treatment on the teeth as they are not stable anymore and as her jaw is no longer growing it is the right time to continue treatment. As the damage was a result of the accident we were informed that the insurance should pay for all ongoing treatment. Since the accident, we have changed (in 2016) the insurance provider and assumed it would be the insurance company we were insured with at the time of the accident that would pay the costs for further treatment. My daughter still has a supplementary insurance with the original company.


However this company is saying that they will not pay for further treatment and the insurance company that my daughter is with now should pay. That insurance company is saying no, that is not correct, the original company should pay. We are getting nowhere.


Can anyone advise us what we can do? Is the original provider legally obliged to cover the accident costs? Would this be written somewhere?



I hope you managed to get to the end! Thanks for reading.

In principle your daughter was treated under the accident cover of the basic health insurance and not the dental insurance. The accident cover is supposed to cover all follow-up treatment, but you may find the insurance company will claim that the new treatment isn't related to the accident.
I would suggest you get your dentist to write down exactly what he/she proposes to do, how it relates to the accident and then you submit it to whoever covered the initial accident (if you've changed insurance companies in the meantime, you need to go back to the one responsible at the time of the accident) and get written confirmation they will cover the treatment.
You may have to fight for this.

Thank you catandmouse for your fast reply.


We have provided letters from the dentist to say that the treatment is related to the accident and why she needs this treatment. All the insurance company says is that the new company should pay. And the new company says that the old company should pay as they were the insurers at the time of the accident.

Im slowly going crazy and am at a loss as to what more I can do!

Do you have legal insurance?

Tom

I know it's your right to do so but in a situation like this changing the health insurance provider is a risky business.

Legal insurance or threaten them with a letter to insurance Ombudsman or to take the to Poursuites.

You will need to fight this very very hard (hence why I personally would not have left the insurance in the first place).

K

Thanks for your replies.


Im now trying to see if we have some legal insurance. I thought we had it on our 3rd party insurance but they are saying no we dont.

Its not my week!!

Hello Swissfi,

I would be quite interested to hear how your story resolves.

We have a similar-ish situation where we might need future treatment for a dental problem caused by an accident a few years back.

Good luck!