UNDERSTAND YOUR DENTAL INSURANCE – Do I have to pay the deductible or percentage difference?

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We are asked on occasion if we can waive the deductible or co-payment that a patient needs to pay and the answer is “no.” It is against the law for a dental office not to collect the deductible or co-payment. Not only is it insurance fraud, but it is against the regulations of the Royal College of Dental Surgeons of Ontario (RCDSO) that regulates dentists. This practice is considered to be professional misconduct and a dentist can lose his/her license and receive a fine.

As a dental office we are here to provide the services and information on available treatment options appropriate to address your dental needs regardless of the nature and extent of your dental coverage and we can also assist you in receiving the benefits that you are entitled to under your dental plan.

It is very important to understand your dental plan as it is a valuable benefit. Many employers provide benefits, in addition to salaries, as a method of paying their employees. In order to be able to offer dental plans to their employees, companies design  the benefit package so that the employee shares in the cost of their dental care. Below is information on frequently asked questions with respect to insurance plans, deductibles, co-payment and co-insurance as answered by the Ontario Dental Association.

What plan limitations are employers using to involve the employee in dental care costs?

Some of the most common benefit plan designs currently being offered are:
(1) Annual Deductible Amounts – In this case, the employee may be required to pay the first $25 or $50 claimed every year.
(2) Frequency limitations – Dental plans may limit the number of visits to the dentist each year that will be covered by the insurance plan
(3) Annual Dollar Maximums Employers may create a maximum limit (e.g., $1,500) that the dental plan will cover each year.
(4) Co-Payment (or co-insurance) Through a sharing formula specified in the dental plan contract, the dental plan may only cover a percentage of the eligible amount claimed. The employee is responsible for paying the remainder.
When are co-payments used?
Co-payments are sometimes applied to diagnostic, preventative and basic services, but they are more frequently applied to comprehensive or extensive services such as endodontics, periodontics, prosthodontics and orthodontics. Sometimes your plan will cover 80 percent of the bill leaving you to pay the other 20 percent (an 80 – 20 co-pay), other times, it could be on a 50 – 50 basis, or even other amounts. It all depends on the plan.
How do co-payments work?
Here’s how it works: Your dentist bills you for $100 for your dental treatment. Before the claim form goes to your insurance company, you sign the claim form, verifying that the charge is accurate and that you are financially responsible to the dentist for the entire charge. This is an important step because your dental plan may not cover the whole bill. For example, if your plan pays 80 percent of an eligible expense of $100, your insurance company will cover the first $80 leaving you responsible for paying the remaining $20 as an out- of-pocket expense.
Do I have to pay the co-payment?
Yes. It is against the law (insurance fraud) for you or your dentist to conspire to avoid paying the co-payment. Not only is it a violation of the law, but it is contrary to the regulations of the Royal College of Dental Surgeons of Ontario (RCDSO) that regulates the dental profession. This practice is considered professional misconduct and a dentist can lose his license for it, as well as incurring hefty fines, often exceeding $10,000.
By law, a claim made to an insurance company must be an accurate description of services rendered and fees charged. This is why you are required to sign the claim form before it is submitted to your insurance company.
How would an insurance company know that I did not pay my share?
Insurance companies reserve the right to request that the patient provide proof that the co-payment has actually been paid. If the patient is unable to provide that proof, the insurance company may demand that the patient make financial restitution to the insurance company or it may apply the over-payment to future claims payments.
What if my dentist gives me a discount on certain fees?
Your dentist may do this but this is very different from waiving a co-payment. If your dentist discounts his/her fee to you by a certain percentage, then that discounted fee must be the fee submitted to your insurance company as the whole fee charged for the services rendered.
Your dental plan is a valuable benefit. Before you ask your dentist to waive a co-payment, think about the consequences to you and your dentist.
For more information on your dental benefits be sure to contact your insurance company or call our office and we can assist you in understanding your benefits.
Dr. Elizabeth Dimovski Dental Office
905-458-6620

How to spot dental problems ….

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Information as per the Canadian Dental Association

Dr. Elizabeth Dimovski and Associates – Dentists in Brampton

905-458-6620

Proper care of your dentures

Brampton DentistBacteria stick to your teeth and also to full or partial dentures. If you wear dentures, remember to clean them on a daily basis with cleaners made specifically for dentures. Do not use toothpastes for natural teeth or household cleaners, which are too abrasive and can damage dentures that can be expensive to replace.

Take your dentures out of your mouth for at least four hours every 24 hours to keep the lining of your mouth healthy. It’s best to remove your full or partial dentures at night. Your dentist will provide you with instructions about how long your dentures should be worn each day. (ADA)

For more information be sure to speak to one of our dental professionals.

Dr. Elizabeth Dimovski and Associates – Brampton Dentists

905-458-6620

Are you nervous or anxious about your dental treatment?

Brampton Dentists, Top Dentist in Brampton, best dental treatment, Nitrous Oxide, Nervous Dental patients, Brampton Dental offices, Nitrous oxide also known as “laughing gas” is a safe and effective sedative agent that is mixed with oxygen and inhaled through a small mask that fits over your nose to help you relax during your periodontal treatment.

Nitrous oxide is one option we offer to help make you more comfortable during your periodontal treatment. It is not intended to put you to sleep. You will be able to hear and respond to requests, questions and directions. Your will be asked  to breathe normally through your nose, and within a few short minutes you should start to feel the effects. You may feel light-headed or a tingling in your arms and legs. Ultimately, you should feel calm and comfortable. The effects of nitrous oxide wear off soon after the mask is removed.

Talk to one of our dental professionals to find out whether nitrous oxide would be a good option for you.

Dr. Elizabeth Dimovski Dental Office

Dentists in Brampton

905-458-6620

Are your teeth going from white to not so bright?

Young Man Smile Before And After Teeth WhiteningHave you noticed your teeth change colour ….. going from white to not so bright?

There are many reason teeth can change colour or get stained. From the foods consumed, and trauma to medication, age and visiting the dentist regularly for dental cleanings.

Food and Drinks

Certain foods and drinks have intense colour pigments that attach to the white outer part of the tooth (enamel) causing colour change. Such foods and drinks are: Coffee, tea, red wine, candy and foods containing colour.

Tobacco

Tar and nicotine create stains. Tar is naturally dark and although nicotine is colourless when mixed with oxygen it turns into a yellowish surface-staining substance.

Age

The enamel of the tooth is white however the layer under the enamel, called dentin, is yellowish. With age, as the enamel gets thiner, more of the yellowish dentin shows through.

Trauma

If you have hit your tooth you may notice it get darker as a reaction to the injury, by laying down more dentin.

Medication

Certain medications can also cause teeth to change colour and darken. Be sure to speak to your dentist if you have concerns that the medication you are taking are causing your teeth to change colour.

The best way to keep your teeth white is to brush twice a day, floss daily, see your dentist for regular checkups and professional cleanings, and limit stain-causing foods and habits. However if you feel your teeth can use a little whitening help, there are a few options you may want to consider:

Chair-Side Bleaching – usually takes about 2 hours.  A shield (or rubber dam) protects your gums from the bleaching agent (usually a form or hydrogen peroxide) which is “painted” onto your discoloured teeth and activated with heat or high-intensity light.

Take-Home Bleaching – is done by you at home. You wear a custom-made tray with special bleaching gel (provided by your dentist) for a period of time each day over a number of weeks. You may also use Crest Whitestrips Supreme which can be purchased at our office.

It’s important to know that not everyone’s teeth will “whiten” the same. It depends on the number of teeth involved and the severity of discolouration. Over-the-counter, at-home whiteners are not recommended because they may cause problems associated with over exposing gum tissues to the active whitening agent. Any bleaching treatment should be done under your dentist’s supervision.

Dr. Elizabeth Dimovski Brampton Dental Office

905-458-6620