Insurance and Dental Benefits

Dental Insurance & Financial Information

We’re here to help you understand your insurance coverage and make informed decisions about your dental care. This guide explains how we work with insurance companies, what you can expect, and the payment options available to you.

Insurance and What to Expect
Our office works with many different insurance companies, each offering a wide range of dental plans. These plans can change frequently—sometimes without notice. While we do our best to give you accurate estimates, your final coverage is determined by your insurance company, often only after your treatment is completed.

Because of this, we encourage you to keep your insurance and employment information up to date with our team. This helps us serve you better and avoid surprises.

We’re happy to submit your insurance claims on your behalf. However, some patients choose to submit their own claims through their employer or directly to the insurance company, which can sometimes result in faster processing.

Electronic Claims
If your insurance company supports the CDA network, we can send your claims electronically. Our systems are set up to use EDI and Itrans.

Please note that our office does not accept assignment of benefits. This means your insurance company will send reimbursement directly to you—not to us. You are responsible for paying for your treatment. This policy, supported by the Ontario Dental Association, ensures you are fully aware of the actual cost of your care.

Common Insurance Terms Explained
Understanding your insurance plan can be confusing. Here are some key terms to be aware of:

• Annual Maximum: This is the most your plan will pay each year. Anything beyond this is your responsibility.

• Deductible: The amount you must pay out of pocket before your insurance coverage begins.

• Co-payment (or Out-of-Pocket Costs): This is the portion of your treatment cost not covered by insurance. Most plans cover somewhere between 30% and 80%, so you’ll need to pay the rest.

• Dual Coverage: If you have coverage under more than one plan, such as through your spouse, you may be able to reduce or eliminate your out-of-pocket costs. Insurance companies will coordinate these benefits, but they won’t reimburse more than 100% of the cost.

• Eligibility: This refers to who is covered under your insurance policy.

• Exclusions: Some procedures may not be covered by your plan, even if they are necessary. These exclusions are often based on cost-saving decisions made by your employer.

• Policy Limits: Many plans have limits on how much they’ll pay for specific procedures or how often you can receive certain treatments.

• Assignment of Benefits: This allows the insurance company to pay the dental office directly. Since we do not accept assignment, payments go to you, and you are responsible for forwarding any insurance funds to our office if there’s an outstanding balance.

ODSP and Government Coverage
Government-sponsored dental plans, including ODSP, typically provide limited coverage for periodontal services. However, Dr. Novack is committed to making care accessible and affordable. If you’re receiving assistance or have limited financial resources, please speak with us. We’re happy to explore financial arrangements that can help.

You can visit the ODSP website to learn more about what is covered.

Financial Assistance for Those in Need
If you’re committed to your dental health but have financial concerns, we’ll do everything we can to help. Our Treatment Coordinator will work with you and Dr. Novack to create a treatment plan that meets both your health and financial needs.

Our entire team is committed to delivering quality, compassionate care. We want you to feel supported every step of the way.

Payment Options
We offer several ways to make paying for your care manageable.

For single-visit procedures
Payment is due at the time of treatment. We accept cash, cheque, debit, Visa, and MasterCard.

For multiple-visit treatments
We offer the following options:

1. Pay in full at each appointment
   This is the most common option. Patients typically pay for treatment as it’s received.

2. Prepayment with a 10% courtesy reduction
   If you choose to pay for your entire treatment plan before it begins, we offer a 10% reduction in fees. This helps us reduce administrative costs, and we pass those savings on to you.

3. Four-part payment plan
   You can split your treatment cost into four equal payments:

   • The first payment when your appointment is booked

   • The second on the day of your procedure

   • The third one month after treatment

   • The fourth two months after treatment

4. Extended payment plans
   If you need a longer payment timeline, please speak with us before treatment is scheduled. We’ll work with you to create a plan that fits your budget.

We’re Here to Help
Our staff is knowledgeable and up to date on insurance plans and payment options. If you have questions about your coverage, costs, or payment choices, don’t hesitate to ask. We’re here to make the process as smooth and stress-free as possible.