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

The importance of regular dental cleanings

Author: Melissa O’dell

Dental Cleaning, Dental Scaling, Tooth Polishing, Fluoride, Dentist Brampton, Family Dentist in Brampton, Brampton Dental Office,Teeth Cleanings\Scaling

Dental cleaning\scaling is when the dental hygienist or dentist uses specialized instruments (hand and /or ultrasonic) to remove plaque (soft, sticky, bacteria infested film) and tartar\calculus (grey, yellow, brown, black) hard deposits from your teeth without harming them. A few minutes after brushing a thin layer of saliva, proteins, and bacteria (called pellicle) is formed on the teeth which acts as a base for bacterial attachment and growth. Eventually with the accumulation of various species of bacteria and sugars from the foods we eat we get a white\yellowish substance called plaque along our gums and teeth. If the plaque is not removed it will attract minerals from the saliva and harden turning into calculus/tartar. If calculus/tartar is left on the teeth it will provide a situation for bacteria to thrive next to the gums which is detrimental for the health of the gums and can lead to gum disease(gingivitis) which leads to periodontal disease which leads to tooth loss. The purpose of the cleaning is to leave the teeth clean and smooth so bacteria is unable to stick to them, reverse gum disease and prevent the progression to periodontal disease.


Polishing/Prophy


Polishing is done after scaling to remove any leftover plaque from the teeth and gums and to remove extrinsic stain. It is done using a slow speed handpiece with a soft rubber cup at the end and a special gritty toothpaste-like material.


Fluoride

Fluoride helps to strengthen the teeth from the acids from bacteria in dental tartar and plaque that can weakened them, it also possesses antibacterial qualities. 

Dentist In Brampton

Dr. Elizabeth Dimovski’s Graham Vicars Scholarship 2016

Graham VicarsDentist in Brampton, Brampton Dental Office, Graham Vicars Scholarship, Dentist Brampton, Brampton Dentist, was one of our awesome patients. It was always a great pleasure having him come in the office as he always carried a smile that put a smile on our faces and brightened up the office.  An awesome person so organized who never missed an appointment. In his memory Dr. Dimovski’s Dental Office is awarding the $500.00 Graham Vicars Scholarship to one of our patients attending post secondary education in January 2016 (College or University). The recipient of the scholarship will be chosen by the Vicars family. All submissions are due by November 23rd 2015. To apply for the scholarship click here.
Dr. Elizabeth Dimovski and Associates – We Protect Your Smile
Dentists Brampton
905-458-6620

Causes of Sensitive Teeth – Brampton Dentists*

Is the taste of ice cream or a sip of hot coffee sometimes a painful experience for you? Does brushing or flossing make you wince occasionally? If so, you may have sensitive teeth.

Possible causes include:Toothache, Sensitive teeth, Dentist in Brampton, Dentists, Tooth Pain, Solutions

  • Tooth decay (cavities)
  • Fractured teeth
  • Worn fillings
  • Gum disease
  • Worn tooth enamel
  • Exposed tooth root

In healthy teeth, a layer of enamel protects the crowns of your teeth—the part above the gum line. Under the gum line a layer called cementum protects the tooth root. Underneath both the enamel and the cementum is dentin.
Dentin is less dense than enamel and cementum and contains microscopic tubules (small hollow tubes or canals). When dentin loses its protective covering of enamel or cementum these tubules allow heat and cold or acidic or sticky foods to reach the nerves and cells inside the tooth. Dentin may also be exposed when gums recede. The result can be hypersensitivity. (ADA)

Dr. Elizabeth Dimovski & Associates – We Protect Your Smile!

www.dentist-in-brampton.com

905-458-6620

Before you decorate your mouth for Christmas know the facts! Brampton Dentists

Tongue piercing, Oral Piercings, top dentist in brampton, brampton dental office, best dentist in brampton, tooth decay, tooth infection,

When it comes to decorating your mouth or tongue you should think twice and know the facts. When asked about oral piercings most dental professionals say no. The risks right after an oral piercing are same as any open wound, including pain, swelling, infection and scar tissue formation, but can be more serious when it involves the tongue.

Risks of oral piercing vary depending on the location of the oral piercing. Common placements of oral piercings are on the tongue, labret (the space between the lower lip and chin), lips, uvula or cheeks.

Piercings through the tongue or lip, or below the tongue, can cause tooth damage such as cracked or chipped teeth. Piercings through the floor of the mouth below the tongue or through the tongue have the highest risk of serious infection as they have the highest blood flow and are closest to the airway. Other risks include nerve, muscle or gum tissue damage. Piercings can also cause the gums to recede which may cause tooth decay and gum disease.

If after knowing all the facts you are still inclined in getting an oral piercing be sure to take precautions to avoid damage to your mouth and self. Below is a list of precautionary measures put out by the Ontario Dental Association, before and after oral piercings.

  • Check out the cleanliness of the place doing the piercing. Do they have an infection-control policy posted? A recent investigation by the Toronto Star and the Ryerson University School of Journalism found that half of the complaints filed against personal service settings in Toronto, such as tattoo and piercing parlours, involved items not being properly cleaned or sterilized.
  • Ensure that the practitioner performing the piercing is experienced and uses strict infection-control practices (an autoclave sterilizer, for example, for non-disposable equipment, and new needles and gloves) to avoid serious infections such as hepatitis B and C, and HIV. Ask for detailed after-care instructions.
  • Disinfect your oral jewelry regularly and brush the jewelry the same as you would your teeth.
  • If piercings are in close proximity to the teeth, make sure the ends, or even the entire stud, are made of plastic.
  • Try to avoid the tongue or the floor of the mouth for piercing because of its higher risk of infection.
  • Seek immediate medical or dental attention if you experience excessive bleeding, swelling or pain following a piercing, or if there is any evidence of infection (an odour or fluid from the piercing, for example).
  • Visit your dentist regularly so that he or she can closely monitor the piercing and any potential damage to teeth and gums.

Dr. Elizabeth Dimovski and Associated – We Protect Your Smile!

905-458-6620