During the past three decades, dental plans have become an integral part of healthcare planning for many families. Today, dental plans are based on a variety of employer options, which include many restrictions that could seriously impact your oral health.
Your benefits are designed to serve as assistance for basic and preventive dental services. Therefore, the type of treatment you need and receive from our practice is based upon professional judgment and not whether you are covered by an insurance plan.
Many insurance policies are negotiated between your employer and the insurance company; therefore, in many cases, we cannot determine for you what your individual policy benefits will pay. As a service to you, we will assist you in your claim processing as quickly as possible so you receive the maximum benefit possible within good time.
The contract for your dental insurance is between you and the insurance company. It has been our experience that companies treat the policy holder with more efficiency and consideration than a dental office, who really has no official dealing with them. This allows us to spend our time looking after you, not the insurance company.
We would be happy to discuss any special needs in the handling of your account, since you are very important to us as a client. We offer a variety of payment options, including cash, Visa, MasterCard, and Interac (direct payment).
In addition to these terms of payment, we would also be happy to arrange for you an individual payment plan that can include post-dated cheques or financing through Financeit or Health Smart to obtain the dentistry you want for a more affordable monthly payment than we, the dental office, can offer.
Many clients have found this to be a great benefit: They receive the dental care they need and can fit the smaller monthly payment into their budget.
Please remember that no question is too small to ask. Stop in or call any time you have a question. We are here to help you.
Things Every Insured Patient Needs To Know
- The name of the person in your company who is in charge of employee benefits
- Name and phone number of insurance carrier
Information patients will be asked to give when calling their insurance company:
- Name of subscriber
- Employee’s date of birth
- SIN number
- Policy number
- Division number
- Certificate number
Questions Patients Should Ask About Their Insurance
- What is the annual maximum allowed per patient?
- What is the anniversary date of the policy? (Example: January 1st)
- Is there an annual deductible? If yes, how much is it?
- Dental benefits are paid on which year’s Saskatchewan Dental Association fee schedule? (example: 1996 or 1999)
- How many units of scaling and/or root planing are covered per year? Which codes are allowed for these services?
- How many recall appointments are allowed annually? (for example: every 3 months, 6 months, 9 months?)
- What percentage of coverage is allowed for the following?
- Diagnostic services
- Preventive services
- Restorative services
- Endodontic services
- Periodontal services
- Major treatment (example: crowns, bridges, dentures)
- Treatment Planning / Consultations
- What is the annual maximum for major treatment?
- Is endodontic and/or periodontal treatment classified as basic or major treatment?
Insurance Terms You Should Be Aware Of
Annual Maximum: Most insurance companies have an annual maximum amount of coverage for each patient listed under the insurance policy. This coverage may be changed and patients may not be informed.
Deductible: The dollar amount the patient pays toward thr treatment total before insurance coverage begins
Eligibility: Eligibility determines who is covered under the insurance policy.
Exclusions: Many dental services and treatments that are clinically necessary are not covered by dental insurance. Their exclusions are usually described in the patient’s insurance booklet, but please be aware that more treatments are being excluded to reduce costs.
Co-Payment: This is the “Out of Pocket” part of the treatment fee that is not covered by dental insurance. Insurance companies will pay a certain percentage of the treatment, but they very rarely cover 100%.
Dual Coverage: This is when both spouses are covered by different insurance plans. The insurance companies usually coordinate the benefits so the patient does not receive more than 100% of the cost of the treatment.
Facts about Changes in Dental Benefits
Did You Know?
- Some dental benefits are changing rapidly with many reductions in coverage.
- Benefit coverage is a contract between yourself, the insurance company, and your employer — not the dentist.
- Dental benefit companies do not inform dental offices of changes to your policy.
- We suggest you get updated information from your insurance company before making dental appointments.
- As a courtesy to our patients, we are happy to help you understand your insurance coverage.
- Dental benefits may not cover 100% of your dentistry.
- Coverage is being reduced drastically. This means that many necessary treatments may no longer be covered by your plan.
- We encourage our patients to be familiar with their dental plan in order to eliminate disappointments with payment and reimbursement.
- Some companies offer 100% coverage of 2002 fees or less. Our fees may be higher than the average dental benefits plan.
- Our fees are based on our clinical expertise, the quality of care, our state-of-the-art equipment, and materials provided.
- If you have any questions regarding your coverage, we recommend that you call your insurance company. We would like to avoid the disappointment of you proceeding with the necessary treatment that the dentist has recommended because you assume it is covered. If you later find out that your plan has changed, or the treatment is no longer covered, you will be unhappy.
- We are pleased to offer our patients a pre-estimate of treatment fees, which can be sent to your insurance company for confirmation of your coverage. This will enable you to plan your finances before commencing with treatment. We are pleased to discuss fees and payment options with you.
- You need to be aware that insurance companies will sometimes send back approvals with a request for cheaper, alternative treatment plans. Our office is happy to discuss any alternatives and choices with you prior to treatment.
- Some employers offer their employees dental coverage, which is minimal and restricts your choice of dentist and treatments.
Our team members are qualified to help you if you have any questions.