Dental Insurance Claims and Payments

We are happy to submit your dental claims directly for you, provided this is a service within your plan.

There are two ways in which you can pay for your services in our office.  One, we can submit your claim to our insurer and direct payment to you.  You will receive payment from your insurer into your bank account normally within 24 hours of submission. You will pay us for the full amount by credit card, debit, e-transfer or cash.  Many patients enjoy this option as they get to collect points on their credit card.

The second option is Assignment of benefits.  Our dental office bills directly to your insurance carrier and does not require you to pay upfront for the services your insurance covers, you only pay out of pocket the difference in your benefits or for services that your insurer does not cover at the time of your visit.

If you’re unsure of which services are covered by your plan or you need help understanding your benefits, we’re here to help. We can provide you with a complimentary benefits check for clarification on your insurance coverage. 

At Willow Dental we are happy to offer our VIP Insurance Plan (assignment of benefits) to all our patients who;

• Have Confirmable Dental Insurance Coverage
• Have Dental Insurance Coverage with a Dental Carrier that Allows Direct Billing
• Are Able to Provide Our Office with Specific Insurance Details as Requested by One of Our Team Members

If we are unable to confirm your dental coverage, or your insurance does not allow assignment of benefits we will NOT be able to direct bill for you, and you will have to pay for your services on the day of your appointment.

Co-Payment

Another factor that must be taken into consideration is the co-payment. Many insurance policies do not cover the full amount of dental fees. They will normally pay 80% for basic services and 50% for other, more major services. The 20% and 50% not covered is referred to as the co-payment. This co-payment amount is to be paid by the patient. Even if there is no co-payment (coverage is 100%) there may still be a portion not covered (that will have to be paid by the patient) because there may be a fee schedule difference.

Services Not Covered

Dental insurance policies do not cover all dental procedures. Most policies cover the majority of procedures (with co-payments and fee schedule differences) however sometimes some dental procedures are not covered at all. An example of procedures that aren’t always covered are Night Guards, Sedation and Whitening. Also, sometimes even covered services won’t be eligible for payment because of frequency or plan maximums

Frequency Limitations

Dental services such as exams often have frequency limitations. This means that they are “covered” (with co-payments and fee schedule differences) but only once or twice a year.  Other services such as scaling units may not have a limitation to the frequency they are use however, have a limit on how many can be used within a time frame.  For example 16 time units per calendar year.

Plan Maximums

Most insurance companies limit the total amount of coverage available by placing a dollar maximum on the total amount of funds they will pay out for each insured member. This is called the plan maximum. This is an important factor because even if you have “coverage” under your policy for dental treatment, if you have no available funds, your policy will not pay out.

Deductibles

Just like car insurance, some dental policies have deductibles. This is the amount that the dental policy will take off the first processed claim of each policy year for each covered person BEFORE they will make payment for services. If the total eligible claim is for $100.00 and the deductible is $25.00 the insurance company will make their payment based on $75.00. Some insurance policies combine a deductible, a co-payment, and a lower fee schedule (which will result in a fee schedule difference) to limit the amount they will have to pay.

Service Dates

Dental offices are required by law to bill dental procedures on the date they were performed. At Willow Dental Associates, your dental services will be billed to your insurance company on the day the dental services were rendered. No exceptions. This means that even if dental work is pre-authorized, the insurance coverage must be in effect on the date of service.

Please note: If your dental procedure requires two or more appointments, your dental insurance must be in effect at the time of all the appointments. Our office will collect your portion of your services on your first appointment, however, the balance cannot be billed to the insurance company until the final appointment.

How Much Do I Pay?

The patient is required to pay all amounts not covered by their insurance company. This amount includes but is not limited to the fee schedule differences, the co-payment, the deductible and any amounts not covered due to frequency limitations and plan maximums.

What can the dental office do?

Due to privacy legislation limitations dental office staff are not usually permitted to contact insurance companies on behalf of patients to enquire as to their individual coverage, frequency limitations, etc. The dental office can send written estimates to determine specific coverage for individual services. However, the above limitations still apply even if procedures are pre-authorized.

What can I do?

We strongly urge that you as a patient seek to educate and inform yourself as to the specific dental insurance benefits available to you. Most companies have a call centre specifically designed to handle enquiries from patients and even online inquiries provided you have a login and password.  You insurer can help you with this.

Canadian Dental Care Plan (CDCP)

We accept the CDCP plan.  Upon booking your appointment, please provide our office with your plan number and ID.  Verification of your insurance is required BEFORE you come in for your appointment.  Please note that the CDCP provides payment on a percentage of the fee schedule set out by the Canadian government.  Our office bills services using the ODA Fee Guide.  There will be a portion of the fee not covered by the CDCP.  The patient is responsible to pay that difference to our office on the day service is rendered.  For additional information regarding the CDCP benefits, visit the CDCP Sunlife site or the government of Ontario website.

Don’t have insurance?

Willow Dental offers easy payment plans for fees not covered by insurance, up to six months interest-free. If you’re in need of a longer timeline, we can work with you to get dentistry now and a payment plan up to two years with Dental Card or Lendcare.