Important Facts About your Dental Coverage
Your employer will provide you with details of your plan (usually through a booklet or the plan provider’s website).
Some limitations which apply may include yearly maximum benefits, frequency limitations (such as 1 xray every 3 years), or a basic percentage maximum (such as 80% coverage) . Certain procedures may not be eligible for coverage or be fully reimbursable. Most plans will cover standard dental fees but not specialist fees, meaning there may be an uncovered portion if your dental plan states 100% coverage. If there is an uncovered portion, it is the patient’s (or guardian’s) responsibility to pay the remainder on the day of treatment.
Contact your plan provider, or visit their website, to gain more information on your benefits.
Oral Surgeon’s Office Responsibilities
Our office tries its best to be upfront and transparent about costs and financial preparation prior to your appointment. It is important to us to make sure you are prepared and ready to pay for your treatment. Our office will:
- provide you with an estimate of costs prior to your oral surgery procedure
- send a predetermination to your dental plan for proposed services
- upon receipt of the predetermination, we will adjust the balance owing accordingly
- send claims on your behalf to your dental plan for services provided by our office
- if there is a secondary plan, we will submit a claim on your behalf after payment is received from the first plan
Patient Responsibilities
There are thousands of dental plans in BC, each one different from the next. In most cases, for privacy reasons, the dental plan will only communicate with the client. Therefore it is important for you understand the details of your dental plan coverage. From you, we except:
- supply our office with the necessary dental plan policy numbers
- be aware of the details of your dental plan coverage (yearly maximums, limitations, ect.)
- forward any predetermination forms to our office via email to reception@westcoastos.com prior to your procedure. If predetermination forms are not received in our office prior to your procedure, you will be responsible for making the full payment (we accept American Expression, Visa, Mastercard, Interact, or Cash). Afterwards, we can send it to the insurance company to set up reimbursement to the plan holder
If there is a secondary insurance plan:
- you pay the uncovered portion from the first plan on the day of your procedure
- when we receive payment from the first plan, we will then send a claim (with proof of payment from the first plan) to the secondary plan as “pay to subscriber”
- the secondary plan will then reimburse you based on your eligibility