How Dental Insurance Works
If you have dental insurance
At Bolton 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.
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. 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.
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
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:
11111-11116: scaling and 43424: root planing
Ask your insurance company: how many combined rootplaning and scaling units are allowed per benefit year?
Are these units per benefit year, calendar year or rolling months?
13214 (1 hour):self care or Oral Hygiene Instruction
Ask your insurance company: is this contributed by my plan?
Ask your insurance company: What is your yearly maximum?
When does my benefit year begin and end?
If you do not have insurance
“Fit your budget” payment plans can get you what you want from eating the foods you used to to having that movie star smile. Ask us about it today!
Did you know: There is no tax on the majority of dental services! That’s right – no HST, GST, PST, or any ST! The services that are taxed are purely cosmetic such as whitening.