Please review the following frequently asked questions about dental health or ask your own question.
Why has my dental office asked for a deposit for treatment?
Why do I have to pay for treatment when it’s covered by my plan?
Dental Plan Details for a patient is protected by the PIPA Act (Personal Information Protection Act) and with such information of a patient’s dental plan being restricted to be viewed by our dental clinic, we may ask for a patient to pay for such services that we cannot has access to view, even if such services are covered in your Dental Plan. It is a patient’s responsibility to be aware of their covered dental services as well as what is limited or even changed. We do however help assist with your claim(s) for payments not covered by your plan and to provide reimbursement from the plan provider.
What is assignment and non-assignment of benefits?
With non-assignments in a clinic, patients are 100% responsible for the entire service of treatment when provided. The dental clinic can and will assist in a dental claim for possible reimbursement via the dental plan provider.
In some cases, a dental plan provider will reimburse the plan holder ONLY if they require patients to pay for the costs of a dental service when given. In all and every situation, patients are responsible for all costs for treatment if their dental plan does not covered it.
My dental office tried to get a pre-determination for treatment; why did my dental plan provider decline it?
A pre-determination, either approved or declined, is not a 100% guarantee of what is covered. Any treatment or services that are not covered by your dental plan provider is under your responsibility to pay. It is good practice to review your dental plan and discuss any concerns with your provider when necessary.
What is a pre-determination?
A pre-determination is an estimate of what treatment your dental plan will cover and what you will be responsible for. Your dental office will submit an outline of the proposed treatment to your dental plan provider prior to proceeding with treatment. It is an estimate only and does not guarantee the final costs you will be responsible for paying. Also note that dental plans may reimburse services if a pre-determination is received prior to treatment if approved by your provider.
Why do I have to pay the co-payment?
How much do I have to pay?
Your payment for services will depend on your dental plan by your dental plan provider. Many of the services provided is covered by a percentage from the dental plan provider while you are 100% responsible for the difference. An example of coverage would include basic services such as regular examinations. A dental plan provider can cover 80% of the costs while the patient is responsible for the remaining 20%. All coverages and costs will vary based on the provider and the plan both you and the provider have set up. The best way to understand your contribution is to review your dental plan with your provider and understand what your coverage portion is.
What is the dental plan co-payment?
Do I need a dental plan?
A dental plan is highly recommended to help assist in costly dental fees. A dental plan provider or an employer can setup a dental coverage plan to help pay for a percentage of dental treatment services.
Many dental plans include a range of diagnostics as well as basic preventive treatments with a high percentage coverage plus other services which can be covered for a portion of the costs. Such treatments can prevent and help with oral care and prevent dental disease and such plans can help your oral hygiene as well as very costly services.
Why doesn’t my dentist/dental office know what my plan covers?
Dental plans are determined by either third party dental plan providers or your employer(s) with your job. All details of dental plans are protected by the PIPA act (Personal Information Protection Act). The dentist, while not aware with your plan details, can assist in understanding your dental plan. It is the patient’s responsibility to understand their dental plan details and coverage including percentage and co-payment costs.
Why can’t my dentist create a treatment plan based on my dental plan coverage?
The dentist’s number one responsibility is your oral health and hygiene. If you require dental treatment or have any problems with your oral health your dentist will be able to provide treatment options to help and assist your oral needs. The dentist’s treatment plan is not based on a dental plan or it’s coverage. The dentist can help assist with a pre-determination quote for your recommended treatment which can be sent off to your dental plan provider.
It is very important to treat your oral health based on your oral health needs not on what your dental plan can cover. At the end of the day it is what’s best for your oral health needs, not what your dental plan will help cover.
Why does my dental plan only cover a selection of treatment?
Your dental plan is to provide services in which to assist in a portion of payment for your dental services. They are based on a general knowledge in which they can or will cover and cannot help assist to every patients unique oral needs.
A dental plan is selected by the patient in a part of a ground benefits plan. Many of the dental plans available will cover a wide range of dental services with a certain percentage, from a first examination to basic and even other services. Please note that dental plans have a limit on what is covered and any additional costs will be up to the patient to pay for such services.
How do dental plan carriers determine coverage?
Many dental plan providers base their plans on the British Columbia Dental Association’s (BCDA) dental fee suggestion guide as a reference. Plan providers choose the treatment services and the percentage to cover using the dental fee suggestion as a first reference. Do note that providers do not always use up to date fee guides to determine coverage as in some cases determination of coverage can use a previous year’s guide. Also take note that dental plan fees may not include all codes in the up to date BCDA guide.
Dentists are not required to follow the fees that are outlined in the BCDA fee suggestion guide or by dental plan providers. Any costs which are not covered by the patient’s dental plan are the patient’s responsibility to pay for.
How can I find out what my dental plan covers? How can I change my dental plan?
All details of your dental plan are protected by the Personal Information Protection Act (PIPA). Your dentist can only help you understand what your plan is. They do not know your plan’s details or any of the changes which may occur.
There are two types of dental plans to consider:
1. Employer’s Dental Plan: If your dental plan is provided by an employer’s benefits package, you should ask your employers or human resource manager for information on your dental plan and coverage along with a copy of the plan booklet. You should also direct any questions regarding your plan to your employers or HR manager and ask for any recommendations in which you would like to change your plan.
2. Individual Dental Plan: If you do not have a dental plan in an employer’s benefits package, you can purchase a private dental plan from a dental plan provider. You can ask a dental plan provider regarding available plans and what they will cover in which you will be responsible for understanding. Be aware of your co-payment costs as it is the percentage in which you are responsible for when you go in for a dental treatment.
Many dental plans are also posted online with information. Make sure you are aware of the correct information of your dental plan. Also be aware of any changes that may occur prior to any dental treatment.
What is dual coverage?
Dual coverage is when two separate dental plans are in place to cover your dental costs, such as a plan for yourself as well as a spouse or family member’s plan. It is very likely that one of the plans is a primary coverage while the second plan provides additional support. This does not always mean a patient will have 100% coverage for dental treatment. Co-payments can still apply for a dual coverage, especially if the two plans are the same.
What does a basic dental plan cover?
Most basic dental plans cover a specific percentage of the cost of dental treatments. The patient is responsible for the difference or co-payment of the treatment that is not covered by the remaining percentage of the dental treatment. Most basic dental plans will cover approximately 80% of the dental treatment while the patient is responsible for the remaining 20%.
What if my insurance plan only covers a dental exam every nine months but my dentist recommends more frequent exams than this?
It is highly recommended to follow the dentist’s recommendations on your oral health and hygiene. The dentist’s first priority is to provide you with the services and treatment to protect your oral health and prevent dental disease.
Ask your dentist if you have any questions or concerns. It is your responsibility as the patient to understand your dental plan coverage as the dentist will not have exact information on what your plan covers. Also ask your dentist about your plan as well as your oral health needs are to ensure your options to make the best decision for your dental health needs.
Why do I need an exam if I don’t have any dental issues?
Dental disease in its early stages does not have any initial symptoms and cannot be reversed. It is highly important to prevent dental disease in its earliest detection and your dentist is responsible to catch any early signs and stop the progress of dental disease before they become a big problem.
Why doesn’t my dentist take x-rays each time I visit the clinic?
X-rays are determined on a case-by-case basis. Your dentist will determine your oral health needs and will conduct an X-ray if required by either a change in your oral health or to update the system when and if necessary.
What is covered during the exam?
The British Columbia Dental Association (BCDA) has developed a patient information fact sheet to provide patients the knowledge on some things your dentists may look for during an exam. Every dental exam is different for every patient including patient’s age, status of your oral health, level of general health, medication intake and lifestyle choices which can influence a treatment. Ask your dentists any questions in regard to your examination or what the dentist is looking at with your appointment.
How often do I need a dental exam?
While the standard visit to the dentist is every six months, a patient’s dental appointment can depend on their current oral health status and dental needs. The minimum to visit a dentist for a checkup is once a year but it is recommended every 6 months to catch any problems and dental disease as well as checking on your oral health. Talk to your dentist about your oral health care needs and the frequency of your dental exam.
Is there anything I can do to limit the cost of dental care?
The best way to prevent costs of dental care is to maintain good dental practices by prevention. You can maintain good oral health by brushing and flossing your teeth daily as well as limit your intake on sugary food and drinks as well as not smoking. Another good way to limit dental costs is regular checkups with the dentist with a regular examination to prevent future problems and maintain good hygiene.
What can I do to avoid any unforeseen dental costs?
The best way to avoid unexpected dental costs is to fully be aware of your current dental plan. Understand what you are covered for so you can make informed decisions on what dental services and treatments are covered by your provider if any. Also be aware of what portions or dental services you must be responsible to pay for. Also base your cost plans on your current dental health and needs simply by asking the dentist on what is best for you.
The dental clinic can also provide a quote on an estimated costs before you proceed with your treatment. Please note that this is just an estimated costs and can change as the reception staff is not 100% aware or experts on what your dental coverage is and what your treatment will actually cost.
Aside from being aware of your dental plan and quotes, good hygiene and oral practices at home can drastically reduce dental costs along with regular checkups with the dentist.
Why can’t a dentist provide a second opinion without an examination?
A dentist must understand everything that influence a patient’s oral health needs. An examination is absolutely required by the dentist to understand all factors which affect your oral health status. A dentist also cannot determine your oral health needs unless they can look at your current oral health.
Can I get a second opinion; the cost estimate seems high?
It is a necessity for every patient to feel 100% comfortable with any and every dental treatment. If you require a second opinion based on cost you are more than welcome to seek a second opinion. Do note that a secondary exam with another dentist will be an additional cost to conduct the examination to determine your oral health and second opinion.
Why are specialist fees higher?
Dental specialists have received additional training and education in their particular field of dentistry. They provide a high level or expertise in their field to provide treatment with their specialty. General practice dentists will refer patients to a specialist when and if required.
Specialist treatment is often highly technical and very complex. It can often involve the use of specialized equipment, special materials, additional staff needs and additional training and education when necessary. This reflects the higher fees as a patient is getting treatment from an expert in a certain field or dentistry.
How are dental fees determined?
Dental clinics work very similar to medical clinics and are required to follow strict regulatory standards in ensuring the highest level of patient safety and care. Dentists are practically running a very small hospital for oral care and are responsible for a number of costs related to operating their clinics.
Many costs of a dental clinic include specialized equipment, sterilization and safety protocols, hiring, training & working with licensed staff and continuous training & education for the entire dental team. Other factors of costs include external lab costs, treatment materials, treatment complexity as well as the location of the dental clinic.
With such many and costly factors to consider, dentists have to determine this for both the clinic, the staff and most importantly the patient.
Are dentists required to follow the provincial fee guide? OR Why does my dentist charge more than the provincial fee guide?
The dentist is not required to follow the BCDA suggested fee guide when determining dental treatment costs. Dentists often determine the cost of treatment on factors such as their office costs as well as the oral health or the patient.
What causes tooth loss?
Tooth decay and periodontal disease are the most common causes of tooth loss. Tooth decay takes place when most of the tooth’s mineral makeup has been dissolved away and a hole (cavity) has formed. While tooth decay primarily affects children, periodontal disease, or gum disease, affects mostly adults. Periodontal disease is an infection of the gums caused by the buildup of plaque, and its earliest stage is known as gingivitis.
How many times a day should I brush my teeth?
Most dental professionals recommend that you brush your teeth at least twice a day. Brushing after every meal (and flossing at least once a day) is also a good way to maintain dental health.
When should a child have his/her first dental appointment?
A child should have his first dental appointment no later than his third birthday. Many dentists recommend a child have his first appointment when his first tooth comes in.
What causes oral cancer?
Tobacco (cigarettes, pipes, cigars, chewing tobacco, and snuff) is the most common cause of oral cancer. Combining tobacco use with heavy drinking can also foster the development of oral cancer. Bad hygiene, prolonged irritation of the oral cavity, and extended exposure to strong sunlight on the lips are among other causes of the disease. Many dentists believe vitamins A and E can help prevent the acquisition of oral cancer.
What are the warning signs of oral cancer?
Early symptoms of oral cancer include: a sore on the lip, in the mouth, or in the throat that does not heal; a lump on the lip, in the mouth, or in the throat; a red or white patch found anywhere in the mouth; unusual pain or bleeding in the mouth; swelling of the mouth; and any difficulty or discomfort felt in chewing or swallowing.