Understanding your Insurance Benefits

With another year coming to an end and a new year beginning, let talk about how your insurance benefits!

Like any other business, dental fees are based on the costs of doing business.  In Alberta the cost of doing business is higher than other provinces.  Please keep in mind that these costs include capital costs for establishing the practice, lease costs, dental instruments, equipment, computers, supplies and other materials as well as salaries for the staff. Dentists in Alberta must also meet the provincial Infection Prevention and Control standards which are higher than most other jurisdictions and come in at a significant cost. Together with your dentist, you determine your dental care needs and review your customized treatment options and associated costs. Many Albertans have dental insurance through their employers or personal plans.  Dental insurance companies reimburse patients for dental procedures and care based on a level of coverage determined by the employer. Most dental insurance plans start over every calendar year (January 1st to December 31st). This means the maximum dollar amount patients are eligible for on their plan also starts over. The denomination of this maximum is either pre-set by the employer or by whichever option the patient chooses within the insurance company (if it is a personal plan). Plan maximums can range from $500 to $5000, however it is ultimately the patient’s responsibility to know this maximum and to keep track of how much they have accumulated towards it within the annual year.  Any difference in coverage and our fees is paid for by the patient.

We are happy to help with insurance predeterminations to see what amount is covered by your insurance plan(s). Predeterminations are based on the doctor’s evaluation of your teeth gathered during your exam. Dr. Ania and Dr. Rustam try their best to treatment plan for the worst-case scenario or most extensive scenario so there is less chance of any surprises at the end of your visit. Their goal as providers is to create a treatment plan that is transparent so both sides fully understand what treatment is to be provided and what priorities to follow.  Please note due to patient privacy act, some insurance plans will not release any information to the dental office only strictly to the plan member themselves. In this case, estimates will then directly be sent to the plan member, whether it is the patient, spouse or parent. If the estimate is sent directly to you, we kindly ask that you please forward to the office so that either Ashleigh, Melissa or Anastasia can decipher the estimate for you.

Another aspect that patients need to remember when it comes to the annual maximum under their plan is if it is a combined maximum. Some insurance companies may provide two separate maximums for basic treatment (exams, hygiene, x-rays, filling etc.) and major treatment (dentures, implants, crown and bridge) or they may combine the two. We encourage our patients to become familiar with the details of their plan so we have a better understanding of what is expected by patients regarding their appointments.

Please keep in mind that dental care is highly individualized and no two treatment plans are the same. Your own oral hygiene and personal health concerns can affect your treatment.  If you have any concerns about your treatment options or fees PLEASE BRING THEM TO OUR ATTENTION PRIOR TO ANY TREATMENT and we will do our best to work through these concerns with you.

***Please be aware that dental insurance is a complex subject.  There are 1000’s of different policies within dental insurance plans, so it is impossible for us to know about every detail, limit or exclusion involved. Any balance not covered by your insurance is your responsibility***

Our PRIMARY goal at R & A Dentistry is to help you achieve optimum oral health! Secondary to this we want to help you maximize your insurance benefits as well as maintain transparency with your treatment plan and subsequent costs. Our amazing admin team is always happy to help answer any of your questions or concerns as well as help you better understand your plan!

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