Phone number:

✆ (905) 685-5055

Dental Insurance

You and your dentist are partners in taking care of your dental health. It’s important to understand your dental plan, what your responsibilities are and where your dentist comes in.

Dental Plans Versus Treatment Plans

Here’s a helpful tip: a dental plan and a treatment plan are two different things.

  • dental plan is usually part of a health benefits package you get through your workplace. It can also be purchased on its own. Dental plans define which treatments are eligible for reimbursement.
  • treatment plan is a personalized approach you and your dentist develop to treat your dental health needs. It is based on individual needs.

Keep in mind that all benefit plans have limitations. Even though treatment may be necessary, it is not always covered in your dental plan.

Your Responsibilities

It’s  important to know how your plan works. Always read the information booklet or other materials available from your benefits provider.

Some things you should know about your plan:

  • What is covered each year?
  • Is there a deductible?
  • Is there a total dollar limit on my coverage?
  • Can I choose a procedure other than the one my plan covers?
  • Will I still be covered if I change jobs?
  • How much am I covered for cleanings and X-rays?
  • How much am I covered for fillings and root canals?
  • What about other treatments like bridges and crowns, dentures and oral surgery?

You should also be aware of your co-payment. Co-payment — also called co-insurance — is the part of the bill you won’t be reimbursed for. Many dental plans have a percentage of the claim amount (typically 20 to 50 per cent) that is not covered by the dental plan.

Can my dentist waive my co-payment?

No — waiving a co-payment is insurance fraud and is against the law. Your dentist could be fined or even lose their license.

The insurance company pays its share based upon the assumption that you will do the same.

Your Dentist’s Responsibilities

Dentists make their treatment plan based on your dental needs. Sometimes, your dental plan coverage and your treatment plan won’t align. If your dental plan only covers part of the cost of your treatment plan, you’ll need to cover the rest.

Your dentist will take you through your personalized treatment plan and answer any questions you may have. They can also help you understand how much may be covered before you move ahead by submitting a pre-treatment form to your dental benefits administrator. Your benefits administrator will provide you with a “predetermination of benefits”. This doesn’t guarantee that the treatment will be covered by your health insurance plan. But it will show you what services are covered and the limitations of your plan.

We are here to help! If you have any questions regarding how your insurance plan works our office is happy to assist

Insurance Break Down (pdf)