Oral health care is not included in the Canadian Health Act (CHA). To ease the burden of oral healthcare costs, many Albertans are provided oral healthcare coverage through their employer, their union or through their provincial government-funded programs, such as Alberta Works, the Seniors Dental Assistance Program, Child Benefit Program or NIHB programer.

Dental Plan vs. Treatment Plan

Sometimes, patients confuse treatment and dental plans. It is important to know the difference so you can budget out your oral health care costs:

• Dental plans are also referred to as dental insurance plans or dental benefits plans and are made to help patients pay for their dental treatments. It is a contract made between a patient and their chosen insurer.
• Treatment plans are the personalized plans that you and your dentist develop together to treat any current oral health conditions and prevent future ones from occurring. It should not be limited to what your dental plan may cover.

It is important to note that your dentist works to treat you, irrespective of your dental plan.   Your treatment plan will always reflect your oral health needs and will not be based on what your dental plan may or may not cover.

 

Get the Most Out of Your Dental Insurance Plan: Understanding the Terminology

Dental insurance uses a lot of terminologies that can quickly become overwhelming and confusing to decipher. Here are some of the most common terms that you will come across when reading your dental plan:

• Deductible- This is the amount you will have to pay out of pocket each annum before your dental plan covers any treatments or procedures. The deductible required will vary based on your plan.
• Co-insurance- This is a dental plan in which you pay for a portion of the cost of a dental service.
• Annual maximum- most insurance policies will have an annual maximum. This is the most that they will pay for dental services within one calendar year.
• Exclusions- These are dental services not covered by your dental plan.
• Premium- the fee charged by insurers and used to fund the insurance plan.
• Direct assignment billing- an arrangement in which your dentist directly bills your insurance provider, so you do not have to pay for the entire cost of your dental service up-front.
• Co-payment- this is the part of the dental bill that is the patient’s responsibility. Most dental plans involve a portion of the claimed amount that is not covered and must be paid for out of pocket.
• Limitations- some dental procedures are not covered by insurance or only come with conditional coverage- these are known as limitations.

 

Understanding Your Dental Insurance Plan

Since each dental plan is unique, it is important to have the skills and knowledge to understand your specific dental plan. At South Trail Crossing Dental, our friendly front desk team are well-versed in every aspect of dental insurance policies and is happy to work with your provider to help you optimize your benefits.

Most dental plans provide complete coverage for preventative dental procedures such as fluoride treatments, exams, and x-rays. Complete coverage means that you will receive these dental services at zero cost to you.   NOTE this is true if the listed cost of service in insurance provider fee guide matches that of the dental clinic’s fees.  If not, then the patient pays the difference between what the dental clinic charges and what the insurance provider ascertains as the cost it covers.

Additionally, most dental plans will cover basic and preventative dental treatments, including cleanings, fillings, root canal therapy, and some dental surgeries such as tooth extractions. They may also cover a portion or all of some major restorative procedures such as orthodontics, dentures, and bridges. In most cases, basic dental work comes with the highest coverage, and major treatments are covered at around fifty percent.

Certain dental procedures may not be covered by your insurance at all. It is a good idea to go over your plan carefully before choosing to undergo any new dental procedure to ensure you know exactly how much could be your out of pocket expense for that treatment.

Understanding Fee Guides

Most dental offices follow a fee guide to set their prices for different types of treatment. Insurance policies also come with their own fee guides. These are two different guides, and it is helpful to know the difference between them.

Dental office fee guides outline the cost of the procedure before the insurance covers any portion of it. Insurance policy fee guides show how much of the cost of each procedure they will cover. Sometimes, these numbers do not match, and you will have to pay the difference out of pocket.

Dual Insurance

In some cases, individuals can be covered by two or more dental plants. This is typically when there is coverage from an employer as well as their spouse’s employer. When this occurs, it is known as dual insurance.

It is important to note that benefits from all policies should never exceed 100% of the total charges. When you have dual insurance, coordination of benefits between providers will determine which provider pays first. In most cases, the plan in which the patient is enrolled as the main policyholder is considered the primary plan, and the plan in which they are listed as a dependent, spouse or partner, is considered the secondary plan. The secondary plan is used once the primary plan pays for the treatment.

Our Dentist Can Help: Understanding Predetermination

Our team at South Trail Crossing Dental understands that dental insurance can be hard to navigate, We are here to help, including submitting on your behalf, a predetermination request to your insurance provider.

Submitting a predetermination involves sending over several documents such as photos and x-rays of your teeth to your insurance provider. Once these documents have been reviewed, the provider can contact you directly to let you know what portion, if any, would be covered by your insurance.  This helps give you an idea of what to expect when it comes time to pay for your treatment.

Please note that predetermination does not involve billing and is only performed to provide you with an estimate of how much you will have to budget for your treatment. Billing will be done once your treatment has been completed.
 

Visit South Trail Crossing Dental

At South Trail Crossing Dental, we aim to help you achieve all your smile goals and maintain excellent oral health. We understand the significant role that finances play in your decision to get certain dental treatments, and we are happy to help you each step of the way so you can get the most out of your dental plan.