Dental Insurance Benefits: Ask Us!

West Vancouver Family/Sports Dentist, Dr. Rodney Shainbom, brings an old-fashioned idea to the practice of dentistry at Dentistry-on-Bellevue: Customer Service!  He values its application not only in the dental exam chair, but in our front office as well, where issues with dental insurance are a daily part of most patients’ experience. Dental plans are notorious for changing their plans, and the details of their benefits can sometimes be quite confusing.  Even some patients with two dental plans are finding they still have a portion to pay for their dental treatment.

Dental Insurance coverage is a contract between the member and the insurance carrier. In most cases, the terms of coverage are negotiated between the patient’s employer and the insurance carrier.  The terms of coverage are fixed by this agreement, and the dentist nor the dental profession have any part in this process. The benefits paid by the plan adhere to the terms of the contract between the plan and the member. It is the patient’s responsibility to understand their dental insurance benefits before they seek services, but we are here to help navigate this sometimes confusing maze of information!

When reviewing what dental work might be covered, Dental Insurance companies break services down into individual components, each of which is associated with a code. Each plan varies, but generally, most plans provide higher coverage for basic and preventive services, such as regular exams and hygiene, and less coverage for major work, such as restorations and root canals. However, each plan’s contracts vary further according to how many of each component is allowed per year (1 or 2 exams, 1 or 2 root planings/polishings/flouride treatments per year, et al). Plans also place dollar limits on how much dental work they will cover per policy year or per calendar year, for the individual and also for their family. Some have deductibles, some do not. And these are just a few of the issues that can affect how much the company and the patient will each pay.

Plans are constantly changing the benefits they offer and notices of changes to insurance coverage are provided only to the patients and contract holders, and not to the dental professionals.  However, with your permission, we can check with your dental insurance company and acquire up-to-date information regarding what your plan provides, sometimes even before your appointment.  Based on this data, we will provide you with immediate estimates of what your basic services will cost before you receive any treatment. For more extensive major services, we will send a pre-authorization request to your insurance company before that phase of work begins. We are therefore an “assignment” dental practice, meaning we will take your co-payment at the time of your appointment and will wait for your insurance payment to arrive soon after. Whatever balance is remaining between your initial payment and your insurance company’s payment will be billed to you to pay in full within 30 days of your appointment.

Most patients find it is more economical to pay for dental insurance than to cover their dental care needs independently. For those with excellent dental health, with no evidence of decay, gingivitis, chipping, breaking or worn teeth, or other dental problems, it may be more affordable to proceed without a dental plan. However, for those with families, and/or who already have dental health issues, investing in dental insurance will be a wise decision, both clinically and economically.

Please remember: Dental insurance companies are an aid in meeting dental expenses more than they are a provider of dental benefits.  Dental benefits are the gains you win from practicing good hygiene, seeing your dentist regularly, preventing problems before they begin! We  recommend the best treatment options for our patients, regardless of what a dental plan covers. We can not allow limitations emposed by a third party to determine the treatment that is in the patient’s best interests. We will work with you in generating your treatment plan, with knowledge of your dental coverage, but we will recommend only what your dental health clinically requires.

The Canadian Dental Association continues to recommend a complete check -up and hygiene services every six months, with annual x-rays. Regular cleanings must be undertaken to maintain optimum gum health, ideally on a six-month basis, although some patients will require more frequent visits.

As a prospective patient, you can call ahead, give us your dental insurance information and we can determine a good estimate of what your insurance plan will pay toward your services even before your first appointment!  We are here to answer your questions and make the process of working with your dental insurance company as problem-free as we can!