Insurance and Dental Benefits
Dental Insurance Information
Our insurance coordinator on a daily basis deals with many different insurance companies and each insurance company administers a myriad of different dental plans. Insurance companies can and do change benefits, co-payments and deductibles, often several times per year. We will do our best to provide you with accurate coverage estimates based upon information available to us. It is however not always possible to accurately estimate a patient’s level of insurance reimbursement. Many insurance companies do not always provide information on the degree of reimbursement you can expect until after treatment has been rendered. Dealing with these companies can be difficult and time consuming. As a courtesy, we would ask that you keep our staff apprised of any changes to your dental insurance. It is important that all information regarding your employment and insurance coverage is accurate and remains current.
Although we will gladly complete and file the insurance claim on your behalf, you may wish to submit the claim yourself. In general, insurers process claims filed directly by the patient or your company’s HR representative faster than those filed by dental offices.
For those insurance policies currently supported on the CDA network, our office is equipped to forward claims electronically (EDI® and Itrans®). Our office does not accept assignment. This simply means that your dental insurance cheque will be sent directly to you, not to our office. This policy is supported by the Ontario Dental Association and ensures you are fully aware of the true cost of the services you received. Our professional services are rendered to you, our patient, not an insurance company. You are therefore personally responsible for payment of all professional services you receive.
Insurance Policy Terms
Annual Maximum – Most insurance plans set annual maximum limits of coverage for each patient listed under the insurance policy. You should be advised that plan coverage and annual maximum limits may change without you, the patient being informed.
Assignment - Dependent upon the insurance policy, should a patient sign the assignment of benefits section of the insurance form, this then allows the dentist to receive payment from an insurance company, instead of payment being forwarded directly to the patient. Our office’s non-assignment policy instead ensures patients are fully aware of the cost of their care, plan coverage and their overall financial responsibilities. Our policy is supported by the Ontario Dental Association and many insurance companies which now insist on forwarding all payments directly to the patient. When an outstanding balance exists on your account, naturally any payments received from your insurance company should be forwarded to our office at your earliest convenience.
Deductible – The dollar amount a patient is required to pay towards their treatment before insurance coverage begins.
Dual Coverage – Dual coverage applies when both spouses are covered under different insurance plans. It is important to advise that the majority of dental plans reimburse in the range from 30-80 percent of the actual costs of periodontal treatment. We are pleased to share that Dr. Novack’s fees remain at or below the current Ontario Dental Association Suggested Fee Guide for Periodontal Specialists. With dual coverage, you may be able to utilize your spouse’s or important other’s insurance plan to reimburse you for that portion of treatment not covered by your primary plan. This may include the co-payment portion. Often in these instances, the majority if not all treatment costs could be covered by a combination of the patient’s and their spouse’s insurance plans. Insurance companies do however coordinate plan benefits to ensure that the patient does not receive more than 100% of the cost of their treatment. We are committed to ensuring you receive the maximum benefits that your plan(s) allow.
Eligibility – Eligibility determines who is covered under the specific insurance policy.
Exclusions – You should be advised that many routine dental services and treatments that are clinically necessary are not covered by dental insurance plans. These exclusions are usually described in your insurance information booklet. For the most part however, the reasons treatments are excluded reflect a desire by employers to reduce their costs. Plan exclusions based upon financial restrictions are totally unrelated to either the validity or importance of those treatments required to improve your oral-periodontal health.
Policy Limits – Most dental insurance plans set yearly coverage limits and often, pay only a portion of the procedure(s) you may require to achieve lasting dental health.
Co Payment – Or “Out of Pocket Portions” represents that portion of the treatment costs not covered by your dental insurance plan. Dependent upon the specifics of your insurance plan, you may be required to pay a certain percentage of the cost of treatment. You should be advised that it is rare for insurance companies to cover 100% of the cost of treatment.
ODSP – Welfare – Unfortunately, both ODSP and Government Sponsored Welfare plans current coverage levels for periodontal services remains very limited. Dr. Novack however has a strong commitment to social justice. In an effort to assist patients of limited means, Dr. Novack offers financial arrangements to make the care he provides, as affordable as possible.
Below is a hyperlink to the ODSP website to provide you with a better understanding as to specifics of government sponsored dental coverage.
Should you be seriously committed to preserving and maintaining your dental health, we would be glad to assist you in any way possible. Our office Treatment Coordinator in consultation with Dr. Novack and yourself has experience in tailoring your periodontal care needs while remaining sensitive to your financial capabilities and concerns.