Understanding your dental benefits
There are more than 30,000 dental plan contracts in Ontario, and each one is a little different from the next. As a smart consumer, you should make it your job to understand the details of your dental plan, and to supply your dental plan administrator with necessary information such as pre-treatment forms, claim forms or supplementary information. You are also responsible for making arrangements for payment to your dentist for the dental care received. Sometimes additional information may be requested in order to ensure that the treatment is covered by your plan. Your dentist will supply any information you request.
Dental plans are designed to help patients pay for their dental treatment. However, not all dental treatments are eligible or fully reimbursable. If your dental treatment is only partially covered, you will have to share in the cost of your dental care. Remember, you are a partner in your oral health. All treatment and care decisions should be made by you and your dentist based upon your actual needs, aside from your coverage. Your dental plan is not necessarily a treatment plan!
As identified on the claim form you sign after you receive a service, you are responsible for the bill. This means you are also responsible to pay for the portion of the bill not covered by your plan the portion known as the co-payment. These co-payments are usually 20 to 50 percent or more of the claim amount. It is illegal for the dentist to waive or ignore the co-payment and a dentist that does this could lose his/her licence.
In other cases, sometimes the fee will prevent a patient from obtaining dental care when its needed the most. For example, a toothache can result in oral infection if not treated on time. This can pose a great risk to patients who are in poor overall health, particularly those who suffer from heart disease. Its better to discuss the situation including fee with the dentist. Often, a better solution can be found rather than having the patient forgo the necessary care. This should involve working out financial terms with the dentist and discussing all possible options.
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 Monday and have the reimbursement cheque before the end of the week, thanks to electronic claims submission.
We are always here to help you and answer any questions you might have!
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