We wish to inform our past, present and future patients that we no longer receive reimbursements directly from your insurance companies. This means that you will pay for denture services directly to our clinic. Submitted claims will then be paid to you.
Payment for services can be by Visa, MasterCard, Interac, cash or cheque. Reimbursement of your covered service is prompt. Most insurance companies reimburse claimants before credit card bills are due.
Assignment means that you authorize your Denturist to accept payment for dental services directly from your insurance company. In the past, we offered to accept assignment as a courtesy to our patients. The following should inform you why we had to make that difficult decision:
Dental plan designs are becoming more complicated. Predicting reimbursement levels has become increasingly difficult. There are more than 30,000 dental plan contracts in Ontario; and each plan can be a little different from the next. In a person’s working career, they may change plans as many as five times.
Most plans have limitations that include the following:
- Annual deductible amounts.
- Frequency limitations of visits and procedures.
- Annual dollar maximums.
- Percentage of fees covered.
- Fixed fee guide (we charge current year fees, your plan may be fixed in the year it was ratified).
Having dental coverage can be a great benefit to you and your family but your dental plan is a contract between you, your employer, and the company providing the benefits.
As the patient, the payment for treatment fees is solely your responsibility.
Dental plans are designed to assist patients to pay for their dental treatment, however, not all treatments are eligible or fully reimbursable.
It is important to understand that necessary treatment and covered expenses are not the same thing.
The Ontario Dental Association and the Denturist Association of Ontario remains firm in its position that dentists/denturists should decline the assignment of insurance benefits. In fact only 17% of Ontario dentists/denturists currently accept assignment.
The insurance companies have become less co-operative when dealing with dental/denture clinics. Dentists/Denturists are often requested to supply supplemental information regarding treatment. More and more, the insurance companies will only send payment cheques to the patient and refuse to send payment to the dentist/denturist. When our office contacts the insurer for information, we are told that the information we desire is protected under PIPEDA, and that the client must request the information. Several insurance companies have eliminated assignment of benefits to the dentist/denturist entirely. The dental office’s administrative costs are higher under assignment. Over the past few years, these costs have increased dramatically.
We will continue to submit claims for you by mail and electronically (when available) if your insurer is online with DACnet. We will make every effort to ensure that proper claims are properly submitted for prompt reimbursement to you.
We will also continue to send predeterminations for major dental work that is deemed necessary for your oral health.
Remember, your dental insurance is not a treatment policy; it is a reimbursement plan. All treatment and care decisions should be made by you and your denturist based upon actual needs, independent of your dental plan coverage.
If you have any questions about this policy, we will be glad to answer them for you.
Your insurance coverage may vary:
In Ontario, most dental insurance policies are based solely on the Ontario dentists’ (ODA) general practitioner suggested fee guide. That fee guide refers only to one type – standard dentures; it does not offer a choice of higher quality dentures.
Your Insurance Plan will pay a maximum of 50% of the suggested fee for standard dentures in that guide. That maximum benefit does not increase even if dentures of higher quality are being constructed.
The Denturists suggested fee guide (DAO) offers a choice of treatment – standard dentures, actually at a lower cost than standard dentures by dentists, or dentures of higher quality with higher fees than what dentists charge for standard dentures.
Because most plans are based on standard dentures, they cover 50% of the cost of standard dentures in any dental office. However, the policy will not cover a full 50% for dentures of higher quality. If you opt for dentures of higher quality you will have to contribute more towards the cost of your dentures, not because the fee is excessive but because the current contract is based solely on standard dentures.
In addition, dental coverage may vary if the contract is tied to the year it was ratified (i.e. it may be the year 2008 but the plan only pays 2005 fees).
The cost of precision dentures (mid-standard) from a denturist is only slightly higher than the total cost of standard dentures (minimal standard) from a dentist. As an oral health-care specialist, the Denturist offers various types of dentures to satisfy each patient’s specific requirements. Your Denturist, in close consultation with you, will determine what those requirements are and how to meet them. State-of-the-art dentures are able to restore your smile as well as be compatible with the sensitive tissues of your mouth.