OUR CALGARY DENTIST OFFICE IS HERE TO HELP YOU UNDERSTAND HOW YOUR DENTAL INSURANCE PLAN WORKS 

Dental insurance policies can be difficult to understand and we are often asked to help patients navigate their plans, which we are always pleased to do.  Some of the more common insurance questions our Calgary dentist office is asked include:

• What is a co-payment and how is it calculated?
  
  
• Do I have an annual benefit limit and how much is it?
  
  
• What is a pre-determination of dental benefits and should I get one?

DENTAL INSURANCE CO-PAYMENTS

Most dental insurance plans require that patients pay a certain portion of their Calgary dentist fees after payment by their dental insurance plan.  This amount is often referred to as a “co-payment”.  The amount of the co-payment will depend upon a variety of factors, including the fee schedule adopted by the particular dental insurance plan, the Calgary’s dentist’s fee charged for the particular treatment and the percentage of that fee that is covered by the dental insurance plan.  The amount of the co-payment a patient must pay for their dental treatment is a percentage of their dental insurer’s stated fee guide.

It is important to note that the percentage at which a particular dental treatment will be covered by an insurer varies depending upon the insurance company, the type of plan with that insurance company and the type of dental procedure.

For instance, for a typical dental hygiene visit with your Calgary dentist, most dental insurers will cover dental treatment such as scaling, polishing and dental x-rays at a rate of 70-100% of the dental insurer’s fee guide.  After payment by the dental insurer of that 70 to 100%, the patient is contractually obligated to their insurer to pay to their Calgary dentist the balance of the dentist’s fee, which is known as their co-payment. Similarly, the Calgary dentist is also contractually obligated to collect the co-payment from their patient.

ANNUAL DENTAL BENEFIT LIMITS

Another important aspect of some dental insurance plans to be aware of is annual policy limits. Although not all dental insurance plans have an annual policy limit, it is a common feature of many dental insurance plans. If your policy has an annual limit, this means that after reaching a certain dental benefit amount, the dental insurer will not pay any further benefits for your Calgary dentist treatment during that benefit year.

Although our Calgary dentist does not recommend that your oral health choices be guided solely by your dental benefit coverage, it is certainly understandable that you would want to maximize your dental insurance benefits and minimize the amount of treatment done with no benefits at all.  A good way to do this is to speak with our NW Calgary dentist (located in Kensington/Hillhurst/Sunnsyside area) about your recommended treatment and, if you are approaching your annual policy limit, determine whether certain dental procedures can be safely delayed so you can take advantage of the following year’s dental benefits. Approaching your dental treatment in this manner is often a possibility, particularly if you are not dealing with a dental emergency and the end of your dental policy’s benefit year is approaching.

DENTAL BENEFIT PRE-DETERMINATIONS

Asking our Calgary dentist for a pre-determination of your proposed dental work can be a very useful tool in planning for your dental treatment.  A dental insurance pre-determination is a request to your dental insurer prior to treatment to confirm the amount of existing insurance coverage for the proposed dental treatment.  Often our Calgary dentist can make this request of your dental insurer on the day of your visit, with the response being communicated through our computer system, or if that is not possible with your plan, a phone call.  If the dental treatment involves major dental work such as crowns, veneers, bridges, sedation dentistry, dental implants or other extensive dental treatment, a request for a pre-determination must be made several weeks in advance of your appointment date to allow your dental insurer time to review x-rays and assess your potential claim.  

Our Calgary dentist is always happy to request a pre-determination of your dental benefits on your behalf.  If you are considering dental treatment but are wondering what your insurer benefits will cover, please call our Calgary dentist office at 403.283.4252 and one of our friendly and knowledgeable team members would be happy to request a pre-determination of benefits on your behalf.  It’s just another way we’re here for you and your family!