All professional services are charged directly to you, the patient. You are personally responsible for payment of bills on your accounts. The insurance company will reimburse you directly. Some companies allows us to file your claim electronically and will reimburse you sooner. Some companies require claim forms to be filled out and mailed in.
Dental benefits vary from insurance company to insurance company and even from policy to policy. For comprehensive and extensive treatment plans, we also submit a predetermination or estimate for the proposed treatment in order to determine what compensation you may receive from your insurance company. Payment plans can be arranged for more extensive treatment plans if required.
Please remember that not all insurance companies cover all procedures. Some companies even have a fixed maximum coverage per year. They do not always cover some of the more advance procedures, such as crowns and implants.
We will prepare any necessary forms or reports to help you collect your benefits from insurance companies. We will be glad to assist you with any questions or concerns you may have regarding your insurance benefits.
About Dental Insurance
Insurance companies are businesses that are interested in making and saving money.
Insurance companies will generally pay for the treatment which is least expensive, regardless of what is best for the patients’ health.
Dental insurance is intended to help you pay for your dental treatment, not to dictate what type of treatment you may choose.
The treatment which the Doctors recommend is the treatment which they feel is the best treatment for your long-term health and well-being.
The treatment which is recommended is required treatment regardless of insurance benefits.
If we were to base your treatment recommendations on what your insurance company will pay for, we would be doing you a disservice.
We pride ourselves on the fact that we present our patients with the best treatment options possible, this is our promise to you.
“Is this covered by my insurance?” is our #1 question.
Get to know your plan.
Dental benefits vary from all insurance companies and policies. If you are one of the fortunate ones to have dental insurance, we would be happy to help assist you.
We do provide:
- direct billing to your insurance
- prepare predeterminations for proposed treatment
- file your claims electronically
- complete/ mail claim forms
- call your insurance company for a breakdown of your benefits.
The treatment options in which the Dentists advise are the options that are best for your long-term dental health. These options are not dictated by what your insurance company covers.
Our fees coincide with the current Ontario Dental Association Fee Guide. Payment plans can be arranged for more extensive treatment that may not be covered by insurance. Please do not let those unused insurance dollars go to waste.
Many dental plans have co-payments, or in other words, a percentage of the claim amount that is not covered by the dental plan. These co-payments are usually 20 to 50 percent — or more — of the claim amount.
Many dental patients believe that the dentist can waive these amounts so the patient doesn’t have to pay the money. This is not the case and the consequences to dentists for not making a reasonable attempt to collect the co-payment are very serious.
Patient Fact Sheet: “Waiving the Dental Plan Co-Payment” comply with treatment regimens;
acquire knowledge about the nature and extent of dental benefits;
become a better consumer of dental care and wise user of dental benefits;
develop an important comfort level for discussing fees with the dentist;
identify areas in the design of a dental plan that could be improved and apprise dental plan sponsors in response.
Under the Dentistry Act, 1991 (Regulated Health Professions Act) dentists are required to make a reasonable attempt to collect the co-payment portion of dental fees for which the patient has payment responsibility.
The profession’s regulatory body, the Royal College of Dental Surgeons of Ontario (RCDSO) is responsible for ensuring dentists adhere to this requirement.
When collection of co payment is not possible
In short, the dentist has a professional obligation to collect the co-payment. On some occasions, the dentist may run into difficulties doing so. On these occasions, the term “reasonable” should be noted, by taking into account the circumstances of the situation. This includes occasions when it is clear to the dentist that the patient cannot afford to pay the co-payment.
The dentist may then decide to cease pursuing the collection. The following options are open to make sure that the dental plan administrator is not misled:
1. Citing the reasons why this decision has been made, the dentist can advise the dental plan administrator of the situation and obtain his or her consent in writing to cease attempting to collect the co-payment and;
2. Also stating the reasons why, the dentist could advise the dental plan administrator that he or she does not intend to collect the co-payment, and that he or she will accept as full payment, the amount the plan administrator will pay under the plan.
In either of these scenarios, no attempts to mislead the dental plan administrator have been made. Intentional misrepresentation by the dentist can result in discipline by the RCDSO, loss or suspension of dental registration and criminal proceedings for insurance fraud.
Insurance companies also reserve the right to request that the patient provide proof that the co-payment has been paid. If the patient is unable to provide that proof, the insurance company may demand the patient make financial restitution to the insurance company or it may apply the overpayment to future claims.
Clearly, waiving the co-payment and misleading the plan administrator jeopardizes everyone involved — the dentist, the plan administrator and the plan sponsor.