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Funny Dental plan

All about Dental Plans

Those of you who have the opportunity to join a company dental plan, as part of an extended health package, may wonder if the expense is worthwhile. Here are a few things to consider.

  • What does the Dental benefit portion cost? If you are a single or retiring person with perfect teeth and not anticipating any extensive dental work to be done, it may be more cost effective to pay for your own dental appointments. This can be true in small companies where the benefits offered can be limited or expensive due to a smaller volume. Also bear in mind any deductibles, percentage co-payments and financial dollar limits/ year. Certain dental procedures, like orthodontics (braces), crowns and dentures are also not fully covered by a dental plan. However, if you have a big family with recurring dental needs, then a dental plan may be very worthwhile. It is best to sit down and calculate the cost/benefit of whether a dental plan will fit your financial budget vs. the need for dental work. In bigger companies, you may have no choice to opt out of a dental benefit as it is part of a complete package.  Remember! All Health and Insurance plans are there to make money. All packages offered are calculated to be in the favour of the plan. So be honest with yourself and decide if you should take the plan.
  • Some of the most common questions a dentist gets asked is "Does my dental plan cover this?" or "I'm not doing the treatment unless my plan covers it!" It is obviously a personal choice of the patient to accept or decline treatment recommended by the dentist. This is where a dental plan can do more harm than good. Due to a plan's limitations, some procedures may not be covered or only a portion will be covered. This is usually a high value procedure, like dental implants or gum grafts. If a person refuses necessary treatment as recommended by their dentist because their plan won't cover the procedure, then they may do themselves more harm in the process. Dentist prefer to treat the patient and not the dental plan.

Once you have decided to get a dental plan and found a dentist to visit, please bring your plan information with you. This includes any dual coverage information ( if your spouse has a plan also). It is also imperative that you inform the dental office if you have recently switched plan carriers. If you do not tell the office and a procedure is done, it is possible that neither plan carriers will honour the treatment done and you will be responsible for the entire treatment out of pocket. This is an entirely avoidable scenario so, please, make sure that your dental plan information is always up to date.

There are privacy laws in place in Canada now which limits the ability for dental offices to check on a patient's plan information, limits and coverage. A patient must know their coverage fully so as they can convey that information to the office. This applies especially to plan limits. Most dental plans have a dollar limit for a year. This limit usually renews on January 1st of the next year.  If a patient goes over the financial limit of the plan and does not inform the office, the patient will ultimately be responsible for that portion not covered by the dental plan. This situation always causes bad feelings between all involved and can easily be avoided.

When treatment is rendered and you are at the front desk, the receptionist will ask for payment of your portion not covered by your dental plan. If you are lucky enough to have a 100% dental plan, then you will not have to pay anything. Most plans in BC nowadays are 80% plans which means the patient will be responsible for 20% of the bill.

All offices would prefer that you settle your bill immediately after your dental treatment. Some offices do not accept dental plans. These offices will process your dental plan claim for you but expect payment from you after treatment. This is true even if you have a 100% dental plan. You will submit your claim yourself and your dental plan will reimburse you for the work done. These are called "Non- Assignment" offices. New patients must always ask if the dental office takes Assignment or not to avoid a surprise when they pay their bill the first time.

Other dental offices will expect payment of the patient's portion of the fee and directly bill the plan for the remainder.

This is a summary of the current dental plan situation in British Columbia. Other Provinces and States may differ in the administration of their dental benefits. For more information on dental plans, please consult your dentist or your plan administrator. If you don't have a dentist, CLICK here and wichDOC.com can help you find one.

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