How Dental Insurance Works
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If you have dental insurance
Find out what you are covered for
If you don’t have dental insurance
If you have dental insurance
At Burlington Family Dental Centre, we will submit your claim directly to your insurance company electronically. We will even provide you with a complimentary benefits check to see what you are covered for.
When you finish your appointment, you pay us, and we submit your claim. Then in a couple of business days, your insurance company reimburses you!
Bonus! Use your rewards cards to earn rewards points. After all, you get your money back from the insurance company in a couple of days anyway.
For example:
1. You finish your appointment and it’s $100.
2. You pay us and we submit your claim to your insurance company instantly electronically (so you don’t have to do it) .
3. If your insurance company pays 90%, then in a couple of business days, you get your $90 back.
4. If your insurance company pays 100%, then in a couple of business days, you will get your entire $100 back and you won’t be out of pocket anything!
“How come you don’t directly bill the insurance companies?”
Less and less so called “assignment dental offices” are doing this. While it seems easier on the patient, privacy policies, complicated insurance plans and costs are causing a lot of dental offices to abandon this practice. Also, due to PIPEDA, insurance companies consider dental offices as a “third party” so they don’t give them information vs. you the patient which is their direct client.
Even the Ontario Dental Association is encouraging moving to “non-assignment”:
Why the ODA Opposes Assignment
The ODA is opposed to assignment of benefits and actively encourages dental plan sponsors to make their dental plans “non-assignment” plans. Many people wonder why the ODA would oppose a process that many find convenient.
The answer lies in the fact that “non-assignment” dental plans can be less expensive than those that allow assignment, simply because the act of a patient paying for their dental care makes them financially involved in their oral health care. This provides very a good incentive for the patient to use their dental plan wisely. Dental claim reimbursement is much faster than it was years ago, and patients are finding that when they pay the dentist directly their reimbursement cheque is received quickly; greatly minimizing the time they are out of pocket. It is not unusual to see the dentist on Monday and have the reimbursement cheque before the end of the week, thanks to electronic claims submission.
Also, many dentists accept credit cards, which typically have a monthly billing cycle. If complex treatment is necessary, dentists can arrange a payment schedule that allows a patient to budget for expenses and get reimbursement that is more conveniently timed.
Active decision-making about oral health care by patients and meaningful involvement in the financial matters of dental care, including the dental plan, is an important part of achieving excellent oral health care.
Source: https://www.oda.ca/visiting-the-dentist/dental-benefits/
Find out what you are covered for
The privacy act prohibits us from finding out what you are covered for. So please contact your insurance company or consult your company brochure to find out.
For new patients – common questions and codes:
1. New patient exam
01103: complete oral exam (adult) or 01204: specific exam
ask your insurance company if you are eligible now and if not, when ?
If they still say “No”, try Specific Exam
2. X-Rays
02112: periapical (checking root tip on upper and lower front teeth)
02144: bitewing (cavity check)
02601: panoramic film (full mouth view)
Ask your insurance company if you are eligible now. If not, when
For existing patients:
1. Cleaning
11111-11116: scaling and 43424: root planning
Ask your insurance company: how many combined root planning and scaling units are allowed per benefit year?
Are these units per benefit year, calendar year or rolling months?
2. Selfcare
13214 (1 hour):self care or Oral Hygiene Instruction
Ask your insurance company: is this contributed by my plan?
3. Maximums
Ask your insurance company: What is your yearly maximum?
When does my benefit year begin and end?
If you do not have insurance
If you don’t have insurance, no problem. We offer “Fit your budget” payment plans that can get you what you want from eating the foods you used to to having that movie star smile for some of the bigger dental services such as braces.
How much is a dentist visit without insurance near me?
If you do not have insurance, then you might want to know how much it could cost for a regular visit. A new patient dental exam and x-rays may cost between $319 and $450. For most people, they wouldn’t have a full exam and x-rays every 6 months unless there is a medical reason. A typical teeth cleaning visit with no exam might cost around $230. If you go every 6 months, it could be an average cost of $680 a year.
The above are just estimates based on some average numbers. The overall cost you incur depends on various things such as how long since you visited, how much care you take of your teeth at home, exactly how much plaque is on your teeth and so on. Ask for a breakdown so you can see for yourself!
Did you know you can buy your own dental insurance?
Is There HST on Dental Services?
Did you know: There is no tax on dental services! That’s right – no HST, GST, PST, or any ST!