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

Dentist in Brampton Ontario, Dental insurance, Waiving the co-Payment, Brampton Family Dentist, Brampton Dental Office,

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

WHAT IS DENTAL FLUOROSIS AND WHAT CAUSES IT? – Brampton Dentists

Joanna SAYS!

Brampton Dentists, Brampton Dental offices, Fluorosis,
Dental fluorosis is caused by excessive amounts of high concentration fluoride exposure during tooth development. It often appears as faint white streaks on enamel in most mild cases and in the most severe cases will appear as a brown mottled spots on the teeth. Usually it is a combination of fluoride sources which lead to the over exposure.  Children between the ages of 1 – 4 are at critical age of exposure. A child is no longer at risk after the age of 8 because all of the teeth have been developed already.
Since fluorosis is permanent and will not go away over time there are some ways to reduce its appearance. Most cases of fluorosis are mild and cannot be seen easily, but for more severe cases there are options such as bonding resin on fronts of teeth affected or veneers. Unfortunately, teeth whitening will often make the stains and white streaks have an almost chalky appearance which will still stand out from the regular tooth colour. The best way to find a solution which will work best for your specific case is to meet with a dental professional.
Dr. Elizabeth Dimovski and Associates – We Protect Your Smile!
Dentist Brampton
905-458-6620

Periodontal/Gum Disease Progression Brampton Periodontist

1. Plaque full of bacteria, that turns to calculus, builds up between the teeth and gums.

2. The gums become red and inflamed caused by the body’s reaction to the bacteria.

3. The bone recedes due to the inflammatory response to bacteria.

4. Pockets are formed (space between the tooth and gum) due to decreased bone tissue.

5.  If the gum disease is left untreated, over time the teeth become loose and may be lost.

Gum Disease, Periodontist Brampton, Implant and Gum Specialist,

Periodontal/Gum Disease Progression

Dr. Elizabeth Dimovski and Associates – Dentists Brampton

Dr. Annabel Braganza – Brampton Dental Implant And Gum Specialist

905-458-6620