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How Dental Benefits/Insurance Work

Our patients deserve the best treatment we can provide. That’s why we recommend treatment based on our professional judgement and your indivdual need, not on whether or not you are covered by an insurance plan. We feel that you, not your insurance company, should choose the treatment that is best for you, and we are happy to discuss advantages, disadvantages, and possible alternatives to a recommended procedure.

Dental benefits (insurance) can be complex. It is your responsibility to understand your dental insurance. Ensure you take the time to review your dental benefits (insurance plan) through your employer or your insurance company on a regular basis as changes may occur.

Frequently Asked Questions about dental insurance:

An insurance policy is an agreement between you and your insurance company, agreed upon by your employer. Questions or concerns regarding your dental insurance must be addressed by the policy holder or patient.

No, dental insurance is meant to offset the costs of dental treatment. The majority of dental plans pay a percentage of the total treatment costs.

The amount a plan covers is determined by how much the employer paid for the plan. This varies from plan to plan. Your policy booklet or employer can provide you with this information.

Although there is a considerable amount of time and paperwork required to deal with insurance claims, we are happy to file the necessary insurance forms for you at no additional charge.

You are responsible for your account with us and any charges your insurance does not cover. If for some reason your insurance is late in payment to our office, you will be required to pay the outstanding balance and collect any amount owing to you from your insurance. We can assist you in completing any additional forms if necessary.

Become familiar with your insurance policy as insurance plans differ. Many plans do not specify fee schedule allowances, annual maximums or limitations. We strongly encourage you to know your plan in order to eliminate disappointments with payment or reimbursement. For extensive dental work, a pre-determination form can be submitted to your insurance company. You will receive an estimate of how much coverage you have – this will allow you to know approximately the amount over your insurance you will have to pay.

Tips for understanding your dental insurance include:

  • Read your benefit booklet. If you have questions, please feel free to ask us at your next appointment.
  • Check the amount of coverage available for both basic and major services, and know the difference between them.
  • Know how often your are eligible for coverage for a check-up and cleaning. These services differ greatly across plans and may change.
  • Ask your insurance company what year of the fee guide they follow, as these guides change from year to year, and your benefits have an annual maximum payable.
  • Be aware of limitations or exclusions in your plan. For example, some plans will pay for only amalgam (silver) fillings in back teeth, and not the additional cost of white (composite) fillings.
  • Know your deductible if you have one.
  • Sometimes an insurance company will send correspondence (or estimates and cheques) to you instead of our office, as we normally request. If this happens, please remember that your account remains outstanding until the balance is paid, and interest is charged for accounts not paid in a timely manner.

Please contact us if you require further clarification on dental service estimates and payment for service.