Dental insurance coverage is common but no two insurance companies offer exactly the same coverage.
You should also be aware that the full cost of treatments, however necessary and beneficial to you, may not entirely be covered by insurance companies. Remember that an insurance company is a profit-oriented business. Therefore, premiums collected must cover benefits paid out and the company's own expenses in order to turn a profit for shareholders. In general, this means that your dental benefits may not cover all of the treatment cost. In some cases, it’s possible that a treatment would not be covered at all. Always keep in mind that your treatment needs and dental benefits don’t necessarily coincide.
To avoid any unpleasant surprises or disappointments, Kanata North Dental Offices advises you to check your benefits booklet or ask your benefits advisor (or insurance company) the following questions:
On what year of the Ontario Dental Association (ODA) fee guide is my dental insurance based?
What is my yearly maximum benefit coverage? Is basic and major combined?
How often am I covered for a new patient exam?
When was my last new patient exam?
How often is a recall exam covered —6, 9 or 12 months? Is it on a calendar or rolling year? Is the coverage the same for adults and children?
How often is polishing covered, and how many units per year are covered?
How often is fluoride treatment covered per year for adults and children?
When was my last scaling, polishing, fluoride and recall exam?
How many units of time for scaling (tartar removal) are covered per year? Are there additional units available if needed? 1 unit = 15 minutes; 2 units = 30 minutes; 3 units = 45 minutes; 4 units = 60 minutes; 6 units = 90 minutes.
How many scaling units have I used this year?
How often is bitewing radiographs covered? Am I eligible now?
Is periodontal assessment covered?
Now that you have all your questions answered and you have checked to see what your benefits actually cover, our friendly front desk team will assist with your insurance claim and make it hassle-free. We will send your claim electronically to your insurance company, which usually results in a quicker reimbursement for you.
Frequently Asked Questions
Q: Does My Insurance Company Pay You Directly?
A: No. Your insurance company reimburses you. Our staff will be happy to assist you with your dental insurance by electronically submitting claims on your behalf. We will help you fill out the necessary paperwork if your insurance company does not accept electronic claims. We accept cash, debit, Visa and MasterCard payments. We find that in most cases, insurance companies reimburse policy holders within three (3) working days.
Q: What Are Your Fees?
A: We follow the current Ontario Dental Association (ODA) fee guide, which the ODA updates annually. Check with your employer or insurance provider to find out if they use the current fee guide or a previous one.
Q: What Is a Pre-treatment Estimate and When Is It Required?
A pre-treatment estimate is sending a proposed treatment plan to your insurance company to find out what they will cover. This is a good idea for expensive work. Most insurance companies do require a pre-treatment estimate when the cost is over a certain amount. The pre-treatment estimate is valid only on the day it is processed. It is a guideline for payment. There are many factors that may influence payment. Keep in mind that your insurance benefits may have been exhausted for the year prior to processing the pre-treatment estimate. The policy may have changed. If you have left your job, you may no longer be covered under your employer's plan. Even if the pre-estimate clearly states that the procedure will be covered, the patient may learn later that the “promised” benefit will not be paid after all. It doesn't happen often, but it can happen. The patient then has to pay in full for the treatment that was performed. At Kanata North Dental Office, we will send the pre-estimate to your insurance company on your behalf.
Q: Are the Fees Lower If I Don't Have Dental Insurance?
A: The fees for a procedure remain the same, whether you have dental benefits or not. Kanata North Dental Office always follows the Ontario Dental Association suggested fee guide. Always keep in mind that dental care is an investment in your long-term health and quality of life.
Q: What If There Is a Treatment That I Cannot Afford?
A: At Kanata North Dental Office, we care about your dental health. That's why we accept various payment methods, including payments on a monthly billing cycle through Visa or MasterCard. If need be, we can arrange a payment schedule that will be convenient for you, allowing you to enjoy the benefits of proper dental care.
Q: Do You Raise Your Fees Often?
We follow the Ontario Dental Association suggested fee guide which is updated annually. Some treatments have a price range rather than a fixed price. In that case, we base our fee on the complexity of the work performed.