At Dawson Dental, we have a patient-first philosophy of care. When developing a treatment plan for you, we consider your concerns and goals and couple them with our knowledge and experience. As trained health professionals, it is our duty and obligation to inform our patients of all applicable treatment options so that you can make an informed decision based on your dental health requirements, as well as understand any health risks associated with delaying or refusing treatment.
It is important to note that treatment is never based on dental insurance plans, but on providing the quality of care that our patients need and deserve. Dental plans are an employee benefit designed to offset the cost of dental care. The procedures and percentages covered by your plan are determined by the plan purchaser, such as your union or employer – not your dentist. Dental plans are not customized to your individual dental health needs and may, or may not, cover all your treatment needs.
That said, you can ensure there are minimal surprises come payment time by studying your dental plan and knowing what’s covered before your dental appointment to understand your portion of costs. While we are here to help answer any questions regarding insurance breakdowns, our team members are not experts on your plan. It is your responsibility as the patient to know your plan coverage, including any changes.
Remember, you are a partner in your oral health! Your dental plan is not necessarily a treatment plan. All care decisions should be made by you and your dentist based upon your actual needs, aside from your dental plan coverage.
Dental Insurance FAQ
Can you provide a treatment estimate?
Absolutely! Our dentists will work with you to review treatment options and provide a cost estimate for the treatment plan before proceeding. Submitting a pre-determination to your plan provider will provide an estimate of what your dental plan will cover prior to treatment. Note: A dentist can only provide an estimate. As with any medical-based procedure treatment planning can change over the course of treatment; this can have an influence on cost.
How are your fees determined?
Dawson Dental follows the Ontario Dental Association’s Suggested Fee Guide which is updated annually. When your employer and insurance carrier determine the amount of money your dental plan will pay for services covered under the plan, they consider the specific circumstances of your company and its employees. They consider such factors as company funds available for employee benefits, the nature and extent of use of the dental plan by the employees, and which version of the ODA Suggested Fee Guide is used by the insurance carrier. Some employers may use a current issue of the guide, while others may use past issues of the guide. That said, there may be a difference between the price your dentist may charge you and the amount covered by your dental plan.
Do you direct bill my insurance company?
We do! You’re busy, and sometimes just making it to your dentist appointment on time can be a challenge, let alone filling out insurance forms. Not to mention, paying for dental care upfront and having to wait weeks to be reimbursed by cheque is old-school – and a real drain on your finances! If you need the convenience of direct billing, we can help!
What is a dental plan co-payment?
Generally, a dental plan will only cover a portion of the cost of any treatment service, the patient is responsible for any charges not covered by the plan, this is called the co-payment. Your dentist has a legal and regulatory requirement to collect the co-payment from all patients.
How much do I have to pay in co-payment?
This will depend entirely on your dental insurance plan and the percentage of treatment covered by the plan. Ask your benefits manager or insurance provider for a plan booklet or information on your specific coverage.
Can my dentist waive my co-payment?
No. The waiving of a co-payment is insurance fraud and is against the law. Your dentist could be heavily fined or even lose their license.
When you and your dentist sign the claim form that goes to the insurance company, you are stating which services were provided and how much, in total, was charged. The insurance company pays its share based upon the assumption that you will do the same.
What is an annual maximum?
Most dental plans have what is called an “annual maximum” or “annual benefit maximum.” This is the total amount of money the dental benefits provider pays for a member’s dental care within a 12-month period. That time period is called a benefit period.
A benefit period can start at different points of the year. If your plan’s annual maximum is say, $1,000, your dental benefits provider will pay for their portion of your dental work based on your plan’s coverage amounts, until they pay out a total of $1,000. If you reach your annual maximum for your benefit period, meaning your provider has paid $1,000 towards your dental services, any services after that are 100% your responsibility until the next benefit period. The annual maximum on your dental plan resets at the beginning of each benefit period.
Do dental insurance plans cover cosmetic treatment?
Though some cosmetic procedures are covered by certain insurance plans, not all will be. Traditional dental insurance plans focus on procedures that are deemed medically necessary. Most cosmetic procedures improve the look of teeth but do not provide any health benefits. Of course, that doesn’t mean that cosmetic procedures are not worthwhile! There is a lot to be said for the self-esteem and emotional wellbeing that cosmetic dentistry can provide. Some of the most common cosmetic procedures include Teeth Whitening, Veneers, and Gum Contouring.
What are lab fees?
Lab fees may also factor into your treatment depending on the type of dental procedure required. Costs are determined by an outside lab and may or may not be covered by your plan. Any costs not covered by your plan are your responsibility. Laboratory Fees Are Not Dental Fees
The fees charged for laboratory services are in addition to the dentist’s professional fee for the service or treatment provided. In most cases, the laboratory services are performed by companies and not your dentist. Your dentist will arrange for a commercial laboratory to do the work to precise specifications that meet your treatment needs.
While the lab fee is passed on to patients, it is not the dentist’s fee. The lab charges passed on to you by the dentist will be the exact amount that the laboratory has charged your dentist to provide the service.
Why are specialist fees higher?
Dental specialists receive additional training in a particular field of dentistry. They bring a high level of expertise to treatment provided within their specialty. General practice dentists will refer patients where a specialist’s care is required.
Treatment provided within specialty fields is often highly technical and complex. It can involve the use of specialized equipment, materials required for treatment, additional staffing needs and ongoing education. All these factors are considered by specialists when determining treatment costs.