POC 4 Dental Coverage: What is it?

Dove96 wrote:Thank you for the post. Dental is always hard with VAC/Blue Cross.
It is the basic dental services I was refused.

I don't know the reason for the crown but I received an implant due to my bruxism. If this is the case for you I can provide information to help. My dentist was amazing getting together the information for the treatment plan and claim.
They did not backdate the claim  to reimburse for the initial crack, repair, root canal and extraction, about $3000 but I eventually got approval for tooth 1-6 implant.

Yes I am curious how you got implants. My teeth are rotting due to Gerds/acid reflux both VAC pensionable. I even have B-Line coverage. I just put a deposit down at a dentist here in Mexico for 8 crowns. However, when I am back in Canada next week I will be see my dentist again and send VAC a new dental plan. So any advice would be appreciated..

Thank you for the post. Dental is always hard with VAC/Blue Cross.
It is the basic dental services I was refused.

I don't know the reason for the crown but I received an implant due to my bruxism. If this is the case for you I can provide information to help. My dentist was amazing getting together the information for the treatment plan and claim.
They did not backdate the claim to reimburse for the initial crack, repair, root canal and extraction, about $3000 but I eventually got approval for tooth 1-6 implant.

I too am having issues with treatment. Again I was refused before Christmas. Read the following, it may help your dentist when they send in a dental plan for you. VAC covers basic dental services including exams, x-rays, cleanings and
restorations to maintain your oral and dental health. As the core, and
crown on tooth 15 are a non-basic dental service, you are only eligible for
the treatment when:- The periapical pathology has been addressed on tooth 15- The rationale and radiographs provided support VAC's criteria
As the conditions for non-basic treatment have not been met, VAC is
unable to approve the core and crown on tooth 15 .
VAC covers basic dental services including exams, x-rays, cleanings
and restorations to maintain your oral and dental health. As the implant,
and crown on implant for tooth 14 are an exceptional procedure, you are
only eligible for the treatment if there are no other clinically acceptable
treatments available and
Page 1 of 2
- When the case for an exception has been made with radiographs and
rationale provided
As the conditions for an exceptional procedure have not been met, VAC is
unable to approve the implant, and crown on implant for tooth 14 .
Your dental provider has been notified of this decision. Please discuss
this letter with your provider

Bit of a Rant, Thank you for listening in advance.
VAC/Blue Cross is denying coverage I had since 2013.
I am pensioned for Bruxism which POC 4 just covers a mouth guard - nothing else. So when I broke a tooth I had to do a new claim to have it replaced consequential to Bruxism. This is after I had to pay for a filling, root canal and then extraction when it fractured again.

I did a claim for damage to my teeth (divided into 3 claims by VAC) in 2013 and all three were approved. Again I received POC 4.
At that time I started getting basic dental. Also any teeth listed in those claims got repaired as required. Great!
Now Blue Cross is denying claims. VAC is shrugging their shoulders and there is no where it says what POC 4 entails.
VAC sent me a "Summary of Assessment" as an answer to what was covered. There is no where in there that states any POC details.
The net does not have POC details. Even the decision letter was vague.

How do I find out definitively what is covered for POV 4 for my claims? No one seems to know and it gets pushed from VAC to Blue Cross back and forth.