Many people tend to avoid going to the dentist because of the high costs involved. Statistics show that at least 50% of patients delay going to the dentist because they’re unable to pay the fees and other charges. Insurance companies do provide coverage for dental treatment. However, patients are often hesitant about making cash payments and then having to go through complicated procedures to get compensation. Often times, minor errors in the reimbursement procedures may result in claims getting delayed for months. Thankfully, patients can now get dental care without having to worry about payment issues. And, the convenience of direct billing at the dentist in Calgary makes it happen. Dental clinics simply coordinate with insurance providers and send bills directly to them.

Understanding How to Get Treatment at the Calgary Dentist with Direct Billing

Most insurance carriers include the cost of getting basic treatment in their packages. But, the dental plan may not cover all kinds of treatment. Further, the coverage provider may expect that you co-pay or cover a part of the bill on your own. When you visit the direct billing dentist in Calgary, she will examine you and give you an overview of the costs involved. You’ll provide the details of your insurance carrier so that the dental facility can send the company an estimate. Depending on the kind of plan you have, the company will revert to the clinic about the charges it will cover. Accordingly, you can decide on the treatment to opt for. After the procedure, the dentist sends an electronic invoice directly to the insurance carrier and collects payment. You’ll only pay the section of the bill not covered by the company.

Insurance Providers May Work on a Percentage Basis

Each insurance company may follow a different system of covering dental treatment. Typically, the coverage depends on the type of treatment you receive.

Preventive Procedures

If you need preventive procedures, the company may follow the 80/20 system where you’ll pay only 20% of the total bill. This rule applies to treatments like,

  • Teeth cleaning, up to one appointment every 6 months
  • Fillings to treat minor cavities
  • Routine checkups
  • Diagnostic tests like X-rays
  • Treating the gums and other oral tissues or periodontics
  • Fees for consulting dental experts other than the attending dentist
  • Root canal treatment
  • Minor surgical procedures like wisdom teeth removals and oral surgery
  • Fluoride treatments for young children
  • Fissure and pit sealants for young children
  • Space maintainers for the dental structure in young children
  • Sedation dentistry with general anesthesia

Reparative Procedures

If you need more extensive care, the company may expect you to cover an equal share of the cost. Accordingly, you’ll pay half the charge for treatments such as:

  • Dental crowns
  • Dentures and bridges
  • Dental adjustments
  • Braces
  • Repairing and recementing bridges, onlays, and crowns

Cosmetic dentistry, veneers, and treatments like teeth whitening that only help with your overall appearance may not get coverage at all. You’ll likely cover the entire cost.

You Cannot Get the Cost of Treatment Waived

An important fact about getting a procedure at the Calgary dentist with direct billing is that the clinic cannot waive co-payment from the patient. Any dental professionals offering to waive the charges can be found guilty of insurance fraud, which is a federal crime. In addition to incurring a fine, doctors risk losing their license to practice dentistry. At the time of finalizing your treatment plan, both, the dentist and you will sign a form, which is submitted to the insurance company. The form carries your acceptance of co-payment. To answer your next question, yes, you can choose to pay for the entire procedure without getting insurance coverage.

Insurance Companies May Have Other Terms and Conditions

Patients hoping to get direct billing at the dentist in Calgary may want to check with the insurance carrier. Many companies have additional terms and conditions depending on the plan you have. For instance:

  • The coverage may be valid only for a fixed number of appointments, each year.
  • There may be a limit on the total value of treatment you can get.
  • Some programs carry annual deductibles. A deductible is an amount the patient must pay before the insurance company begins making payments. For instance, if you have a deductible of $500 as part of your insurance plan, you’ll cover the first $500 cost of any treatment you receive. The insurance provider will carry the balance amount. However, the coverage is only up to a specific sum as outlined in your policy.
  • It also helps if you know about the exact date when the policy expires. You’ll provide all these details to the dental clinic when discussing the treatment plan.

An important factor to keep in mind when estimating out-of-pocket costs is that getting emergency dental treatment can be more expensive. Check with the provider about the compensation they offer for emergencies. You might find that the co-payment percentage is higher or that you’ll owe a higher deductible in case you go for after-hours or urgent dental treatment.

Look for Dental Programs that Offer Coverage for Families

At the time of buying insurance, you could look around for plans that cover children’s dentistry and senior dental care so you can bring down the costs of treatment the family will need. If you’ll need dental care coverage for kids, make sure you enquire about the costs of braces and any other child-specific treatments. Alternatively, you can opt to get secondary insurance to cover the additional expenses that the primary provider does not carry. When processing your request, the insurance company may send you a “Release of Information Authorization Form.” By signing the form, you’ll authorize the insurance provider to review any additional information related to your claim. Verification of certain details may be needed to make sure the claim progresses smoothly when getting treatment at a direct billing dentist in Calgary.

Your Workplace May Have Dental Benefits for Employees

Many employers offer their staff dental benefits as part of workers’ compensation plans. Though, the amount of coverage can depend on the budget the company can allocate to the program. Accordingly, your employer will have an agreement with a particular insurance provider for covering the cost of specific dental treatments. You can expect to get basic oral care including cleanings and scalings. Scaling or dental planing is a procedure where the dentist reaches under the gumline to remove the accumulation of plaque.

Your employer or the human resources department where you work will give you a detailed guide. This guide outlines the agreement your company has with the insurance provider. The booklet will also include information about the deductibles and exclusions, so you can make an informed decision. Do keep in mind that even though your employer has a dental benefits program for you, it may not cover the entire cost of treatment. For this reason, it is best that you study the guide, which lets you know exactly what your out-of-pocket expenses are likely to be. On your part, you can choose Calgary dentists with direct billing that you know well and have visited frequently over the years. Requesting for discounts and lower fees wherever possible can also help bring down the costs.

What if You No Longer Qualify for Employee Dental Benefits

Changing life situations may result in having to quit the job that entitles you to dental health benefits. For instance, you might retire or switch to a freelance contracting career. Or, you may change jobs and get a part-time position. If you wish to continue working with the current insurance provider, contact the company and inform them of the changes within a 90-day period. As long as you make a premium payment within the prescribed interval, the provider will likely continue with the coverage. You must also inform the clinic where you routinely get treatment.

Understanding the Charges for Laboratory Services

Your dental treatment may need additional services that the clinic does not provide. For instance, your dentist may have to place an order for customized inlays and onlays which are designed at a specialist laboratory. You’ll cover the charges for these services in addition to the dentists’ fees. When preparing the payable bill, the Calgary dentist for direct billing adds the cost as a separate item exactly as paid to the lab. Typically, the cost carries the 99111 code to ensure that = it is clearly identifiable.

You’ll pay for the lab services according to the applicable percentage in the insurance plan. In case your employer is covering the dental charge, the percentage paid by the insurance carrier will depend on the specific program or agreement they have in place. You’ll pay the balance of the charge. If you intend to get coverage with direct billing at the dentist in Calgary, you’ll receive an estimate along with the laboratory charges clearly stated. After checking with the insurance provider, the dental clinic will inform you about the exact cost you must cover. This facility allows you to work out the type of treatment you wish to take.

How Dentists Coordinate with Your Insurance Provider

Direct billing dentists in Calgary coordinate with insurance providers using standardized software. These applications allow the clinics to connect directly with insurance companies and work with them using unique identifiable codes. Since Alberta does not follow a particular fee guide, dental facilities must work according to the fee system that the insurance carrier follows. Should you opt for direct billing at the dentist at Calgary, you’ll provide the identification number assigned to you by the company. Using these details the clinic gets in touch with the company electronically and works out the actual costs included in your plan. Understanding how insurance plans work can be a complicated thing for the average patient. You can rely on the assistance provided by the clinic to guide you through the costs, expected coverage, and cash payment you’ll make.

Most insurance providers add up billing in units where each unit comprises of a 15-minute session. Each year, you can expect to get 8 to 12 units. For instance, say, you have an appointment for teeth cleaning that lasts for around 45 to 60 minutes. That should use up about 3 to 4 available units in a year. Each procedure is identified by a unique five-digit code that helps streamline the billing and cost estimation process. In case you do need additional units or appointments, the dental clinic will help you work out a suitable payment schedule after consulting the insurance provider. Do remember to continue paying the insurance premium for dental coverage each month even if you’ve reached the annual limit.

You Can Opt for an Easy Payment Plan

When discussing the co-payment with the Calgary dentist for direct billing, you can inquire about any easy payment options the clinic provides. For instance, you could work out a plan where you’ll pay a small initial amount and cover the balance in easy installments. In case you’ll need extended payment time frames like say, 48 months, check with the direct billing dentist in Calgary. The clinic may allow you to make small payments with the addition of nominal interest.

Getting dental treatments can be challenging when you need extensive care that is likely to cost more. But, plans for direct billing with the dentist in Calgary can put the procedures well within your reach. Discuss your options with Dr. Jennifer Silver at Macleod Trail Dental and ask about the best solutions available to you. If you’re ready to schedule an appointment, use the Contact page to add your query and we’ll get back to you with responses. If you would like an answer right away, call us at this number: (403) 253-1248 and speak with one of our consultants.

References:

  1. Dental Care FAQs
  2. Understanding Co-payment
  3. Information Package for Dental Hygienists
  4. Are You Covered?
  5. UIN, Claim Forms & CDHAnet

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calgary dentist jen silver

Dr. Jennifer Silver is one of the top dental surgeons practicing in Calgary, Alberta using an innovative multi-disciplinary approach to helping her patients. She believes in offering expert advice and make recommendations to patients just as she would to a family member. Dr. Silver collaborates with a large network of specialists and taps into their expertise to provide holistic care.

Dr. Jennifer Silver has earned a Doctor of Dental Surgery degree from the University of Melbourne, Australia. Her academic qualifications include deans honours list, an oral surgery award and best research project. Before attaining this degree, she graduated with honors from Dalhousie University’s Dental Hygiene Program and worked in the sphere of dentistry for 10 years. Dr. Silver is currently helping patients with dental issues such as TMJ pain and sleep apnea in addition to dentistry. She is keenly interested in constantly upgrading her skills and hopes to gain additional training in oral surgery in the future.