Understanding The Role of Your Dental Benefits, Your Insurance Plan's Dental Fee Schedule, and Your Dental Office
Did you know...
Dental benefits coverage involves a contract between yourself, the insurance company and your employer (in which case your employer purchases benefits for its employees), but not the dentist.
Due to Canada's privacy acts, your dental office staff cannot collect all the information they need about your dental benefits.
Some dental insurance plans change rapidly, possibly reducing your coverage. Insurance companies do not inform dental offices about changes to your dental benefits.
Dental benefits do not always cover 100% of your dental needs. Dental insurance typically covers 80% to 100% of a basic procedure’s fee, 50% of a major procedure’s fee, or less in some cases. However, this coverage is based on the insurance company’s internal fee schedules, and not your dentist’s fees. We put together our fee schedule based on our clinical expertise, quality of service, and material costs, and these fees may be higher than your insurance company’s (please see the dental service fee section for a detailed explanation * coming soon). Ultimately, you are responsible for paying the dentist’s treatment fee. The dental insurance company will reimburse you for your treatment according to its internal fee schedule and payment policy.
We suggest that you get updated information about your dental benefits before visiting a dental office. You can do so by reading your current benefits booklet, or calling your dental insurance company (instructions coming soon *). If you need our help in explaining your dental benefits, you can send us your information by e-mail to drkwok@askdentalclinic.ca, or by bringing your dental insurance booklet to our office. We are happy to help you better understand your dental benefits.
Unfortunately, your dental benefit booklet may not give sufficiently detailed information for a given procedure. In many cases, the insurance company’s exact fee schedule for a procedure is not directly available to either the dental office or the patient.
We would be happy to provide a pre-authorization to send to your dental insurance company to confirm your coverage. This will let you to plan your finances before proceeding with a treatment.
Need help understanding your dental insurance? Contact us today, we can help.