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Dentists Treat You, Not Your Dental Plan

Dentists Treat You Article Image

According to the 2010 Canadian Health Measures Survey, 62% of Canadians have a dental plan, but many don't realize that group plans aren't designed to meet individual health needs.  "Dental plans are a valuable component of extended health benefits and are designed to offset the cost of dental treatment," says Dr. Hank Klein, President, British Columbia Dental Association (BCDA).  "Understanding how dental insurance plans work can help patients make informed choices in partnership with their dentist or dental specialist."

Dentist's responsibility

Just like your physician, your dentist or dental specialist is highly trained.  Treatment recommendations are based on your dental health needs, not dictated by your dental coverage.  A dental plan is a contract between a third party (like your employer), and the insurance company.  The procedures and percentages covered are determined by the contract, not your dentist.   Your dentist can help you understand your coverage and assist you in getting pre-authorizations for treatment.  This will provide you with a good estimate of what will be covered by your plan, and what you will have to pay-before the treatment starts.

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The Dental Plan Co-Payments

The Dental Plan Co-Payments Article Image

Dental plans are a valuable extended health benefit to offset some of the costs associated with dental care.  Understanding your plan coverage in partnership with your dentist will help you avoid surprise costs.

What is the co-payment?

As with most insurance plans, there is usually a deductiblethe amount you have to pay over and above your coverage.  Many dental plans cover a percentage of the cost of treatment.  Regardless of the actual costs, most dental plans cover between 50% to 80% of the cost of dental care.  Any cost not covered by the dental plan is called the co-payment and it is the patient's responsibility to pay the dentist this amount.

Can my dentist waive the co-payment?

Dentists and dental specialists are legally and ethically required to collect the copayment from patients.  When the dentist and patient sign the dental claim form they are confirming the treatment provided and the total fee charged to the patient.  You expect your dentist to be honest with you about the treatment you need.  Your dental plan company expects the same honesty when your claim is submitted for payment.

Continue reading article in PDF format here.