About Dental Insurance
The dentist’s rates are the same for everyone, with or without dental insurance. It is the LAW. During your visit, your dentist will ask you for your insurance details for the transmission of your documents and for electronic invoicing. However, it is important to know that insurance companies only talk to the insured person and do not contact the dental clinic. We can prepare for you the estimates and claims to be sent to your insurance company, but the answers will be sent directly to you. When your insurance plan allows it, an electronic transmission is processed on the same day of the treatment and you only have to pay for the portion of the treatments that is not reimbursed by your package.
Here is some general information about dental insurance:
- Each patient is responsible for checking with their dental insurer for details related to their insurance plan. The dental office is not authorized to receive this information directly. Patients can receive assistance from the dentist’s office to better understand their package and ask relevant questions to their insurer.
- Each member of the same family has his or her own amount of insurance provided for in the package and this amount is not transferable to anyone.
- Most dental insurance plans offer a limit amount per year, usually around $1,000. It is the patient’s responsibility to monitor the progress of his dental expenses and to ensure that he does not reach his limit, in which case he will have to pay the difference. The dental office is in no way responsible for monitoring these costs.
- Most insurance companies set a frequency of preventive visits (examination and cleaning) every 6, 9 or 12 months. The patient may choose to follow his or her insurance plan, but should be aware that the frequency paid may not be appropriate for his or her oral condition. This frequency is not related to the prescription of the dentist and his team, performed according to the real needs of each client’s dental health.
- Some insurance companies reimburse the cost of treatments according to the Association des dentistes du Québec (ACDQ) fee guide for previous years. It is not uncommon to see reimbursement based on a rate that is several years old.
- Some dental insurance plans provide a deductible amount to be paid at the beginning of each year or on the start date of the contract. This amount generally varies between $25 to $100 depending on the package.
- Patients covered by their dental insurance for major care (crowns and bridges, for example) must go through an assessment and evaluation process with the consulting dentist of their insurance company before their expenses are approved and reimbursed.
- Some insurance companies reimburse the cost of composite resin restorations (white fillings) at the same price as amalgam restorations (grey fillings). (Hypothetical case: a molar repaired with a white filling costs $110, but the treatment will be reimbursed at 80% of the amount of the grey filling ($100). The customer will then have to pay a difference of $30.)