Dental Benefits are always a hot topic around our office. Having dental coverage is great for helping pay for your dental treatment, however, it may be harmful to your oral health if you are allowing your benefits to determine dental treatment. In this blog we attempt to explain insurance benefits, and the subscribers’ responsibility when dealing with coverage.
Will my insurance cover treatment?
If you have dental insurance, you are extremely lucky since many people are without health and dental coverage. It is important to see dental benefits for what they are: a way to assist you in paying for dental care. Dental insurance should never influence what treatment or appointments you need. All of our Dentists and Hygienists recommend treatment plans based on your oral health requirements which may be different than what is covered by your insurance plan. It is ultimately your right to decide whether or not to go ahead with our recommendation.
A common example of a treatment plan required but not always covered by insurance is Periodontal scaling. Periodontal (gum) diseases can range from gum inflammation (gingivitis) to a more serious disease that can result in bone loss, and eventually mobile teeth and tooth loss. The primary cause of gum disease is an accumulation of bacterial plaque at and under the gum line. When this plaque is not removed, it hardens and forms calculus that brushing cannot clean. Only a dentist or hygienist can remove calculus. For this reason, your hygienist may recommend three or four month periodontal scaling appointments (more cleanings). With more frequent hygiene appointments and good home dental care, the progression of gum disease will slow down. Scaling (cleaning) is billed by time according to the Ontario Dental Fee Guide. Your insurance plan has a certain amount of time units allowed for scaling, which may or may not be more or less than what your hygienist recommends.
If you do not understand why your provider recommended a certain type of treatment, please ask questions! Why do I need this? How much will it cost? What else can I do to help improve or prevent this? We want you to make the best decision possible based on your needs and not what your insurance covers. We are happy to discuss payment plans, or help by submitting estimates to your insurance so you can maximize your benefits.
Why don’t you accept my Insurance payment directly?
We hear this question a lot and understandably so! Dental treatment is expensive, especially when you have to pay up front. In Canada when you have a doctor or hospital visit, you are not required to pay directly, so many people do not understand the high cost of providing health services. Dentists have to pay for staff, materials, equipment and have other operating costs which is why dental care is expensive. One of the biggest reasons we do not accept your insurance payment directly is Insurance Company privacy laws. There are many insurance companies who will not speak directly with your dental providers, in order to maintain your privacy. This makes it extremely difficult to find out about coverage, payment, etc. By universally not accepting insurance payments, we are spending our time booking your appointments, assisting with your treatment plans, and answering any questions you may have regarding our office or your dental care. We would rather assist you, than spend our entire day imputing cheques, or occupying the phone lines with calls to the Insurance companies. Most benefits now do allow for direct deposit, which means a faster payment to you. Our patients who have signed up for this usually have reimbursement within 24 hours. They appreciate the points they may receive through different credit card reward companies as well when they pay for treatment rendered.
What does my Insurance Plan cover?
The answer to this question is far from simple. Every insurance plan is different and varies depending on the benefit carrier and the level of coverage decided by your employer. Due to the privacy laws by Insurance Companies, we cannot call and get a general breakdown for some plans, therefore, it is your responsibility to be aware of your coverage and let us know if there is something you are declining due to ineligibility. We will help by submitting estimates, inputting coverage notes in your file, and can go over your dental coverage booklet to better help you understand your benefits. Again, it is important to stress that your benefits are there to help pay for your treatment and should not be held solely responsible for all treatment recommended.
If you have other questions regarding Insurance, treatment, or treatment plans, do not hesitate to reach out to us! We are here to assist you and provide the best dental care possible to ensure good oral health.
Written By: Felicia Sprague
Leaside Dentistry Practice Manager