Receiving a dental treatment costs money. There are numerous ways to pay your dentist bill including a dental insurance plan through your employer, union, association, school, government - municipal, federal or provincial, or other organization.
Your Dental Insurance Plan
The information about your dental insurance plan is available from your group dental plan administrator. You should read the booklets and other materials they provide. You need to understand what your plan covers and the extent of the coverage. If you have a dental insurance plan, you should know at least the following:
Dental procedures covered each year
Deductible amount – can be a percentage or a dollar amount
Total dollar limit, if any, on your coverage
Coverage of frequency of regular visits – 6 months, 9 months, 12 months, other
Extent of coverage for teeth cleanings and X-rays
Restrictions, if any, on choosing your own dentist versus having to see a dentist on the list provided by the dental insurance company
Restrictions, if any, on choosing a procedure that is not covered by your dental insurance plan
Expiry of or change in dental insurance coverage, if your change or leave your job
Your co-payment or co-insurance is the part of the dentist bill you will not reimbursed for by your dental insurance plan. An 80/20 co-payment is common for basic procedures such as X-rays, dental cleaning, dental cavity fillings and root canal therapy. This means that the dental plan covers 80% of the dentist bill. A 50/50 co-payment is common for major procedures such as crowns and bridges. This is slightly different from a deductible, which is a fixed amount which a patient must pay during a given period (let’s say a year) before their insurance benefits kick-in.
More Than One Dental Insurance Plan
You may have dental expenses coverage through more than one dental insurance plan because:
Your spouse or common-law partner also has a group dental insurance plan of their own
You have more than one job and have dental insurance plans at all jobs
You are a student and you and your parents have dental insurance plans
You can claim dentist expenses to more than one dental plan. When this is the case, because of overlapping dental insurance coverage insurance companies coordinate benefits and follow rules, some of which are:
If you have dental expense coverage with your employer plan and as a dependent with your significant other’s plan, your employer plan pays your claim first and your significant other’s plan pays your dental claim second
If you have the same status under more than one dental plan, the dental plan that covered you first (coverage for longest period of time) pays first
Dependent Children’s Dental Coverage
When both parents have dental plans and their children are covered under both dental plans as dependents, the dental plan of the parent with the earlier birth date in the calendar year pays first. For example, if parents’ birth dates (not dates of birth which include years of birth as well) were January 17 and February 9, the dental plan of the parent born on January 17 pays first.
In instances, when both parents have the same birth date, the plan paying first is based on the parents given name that occurs first in the alphabet.
In cases of Single Custody, the dental plan of the parent with whom the child resides pays first. The spouse of the parent with custody pays second and the plan of the parent not having custody pays third.
In cases of Joint Custody, the dental plan of the parent with the earlier birth date in the calendar year pays first.
If you are student or have a part-time job and also have coverage as a dependent, your own dental plan(s) will first and your parents’ plans second.
If you have a retiree dental plan and a part-time job dental plan, your retiree dental plan will always pay second. If you have two retiree dental plans, the dental plan that has been in effect the longest pays first.
If you have both group plan coverage and individual plan coverage, your group plan MAY pay first but it depends upon the provisions in your dental insurance policy. So, please check your policies.
Dental Expenses Reimbursements/Payments
The dental plan that pays first calculates benefits as though duplicate coverage does not exist. The dental plan that pays second calculate benefits for each individual item on the claim based on the lowest of (i) the amount that would have been payable had it been the first plan, or (ii) 100% of the eligible expenses minus the benefits paid by the first plan. There may be a limit on the number of visits per year to a dentist and annual dollar maximums.
The importance of this is that it is possible to get reimbursement of dental expenses up to 100% without having 100% coverage under each dental plan. Of course, if the combined payments from all dental plans are less than the total dental expense incurred, you will have to pay the difference out of your own pocket.
At Dentistry on Queenston in Hamilton, you and your dentist together develop a treatment plan based on your oral health needs and situation, not your dental insurance plan coverage.
Pre-Determination of Benefits
Our patient-friendly staff at Dentistry on Queenston in Hamilton are glad to help you get an estimate of how much will be covered before you move ahead with the recommended treatment. We can submit a pre-treatment plan to your dental plan administrator for a pre-determination of dental benefits. This reduces the chances of your dental claim for reimbursement being limited or declined by your dental insurance provider.
If you don't have dental insurance, we offer easy payment plans. We also accept debit cards, Mastercard, Visa, cheques and cash.
If you have any questions, please feel free to call our dental office in Hamilton, ON at 905-561-7310.
Disclaimer: The above information is compiled from reliable sources. However, the rules and your dental insurance coverage depends upon the insurance policy you have.