It is important to understand that your dental office does not know the details of your dental plan coverage; this information is protected by the Personal Information Protection Act. However, your dental office can work with you to determine what services may be covered.
Before you visit the dentist always ensure you have the most recent information on your plan and ensure you share any relevant information with your dental office, such as changes to your plan, any recent claims and/or past treatment that may affect your coverage.
Once you review, discuss and agree on a treatment plan with your dentist, your dental office can submit a predetermination to your plan provider. A predetermination provides you with an estimate of what costs your dental plan will cover and what you will be responsible for. Please be aware this is not a guarantee of coverage.
Important Note: A predetermination is usually valid for a fixed period of time (i.e. six months to a year) however, it is based on available coverage at the time the predetermination is submitted and approved. Therefore, it is important to be aware that if, between the time a predetermination is obtained and the time you receive treatment there are any changes and/or any limits reached on your plan, the final amount of the treatment your plan covers may change. If you have any doubts, reconfirm coverage with your plan provider before your treatment takes place.
Confirm if your dental office offers assignment of benefits. This is a service offered by some dental offices whereby they submit a claim to your plan provider for the covered portion of care; you then pay for any costs not covered. Some offices require patients to pay for the full cost of treatment (this is called non-assignment) and provide you with a completed claim form for you to submit to your dental plan provider to reimburse you directly. This is not uncommon in specialists' offices. Speak to your dental office before treatment begins so you understand what costs you will be responsible for at the time of care.
Your dental office may incur various expenses in preparation for your treatment. In such cases, your dental office may require a deposit to cover some of these initial costs.
The fee that your dental office charges for a particular service/treatment may be different (higher or lower) from the rate your dental plan provider reimburses. You are responsible to cover any costs not covered by your plan.
Also review the Frequently Asked Questions: Dental Plans