Dentistry and insurance

September 5, 2011

When you go to the doctor for a physical, the doctor’s fee is paid by OHIP. But when it’s time for your biannual dental checkup, there’s no provincial plan that covers your costs. Workplace dental insurance plans cover many of your dental expense. However, every plan is different, and your provider may have different guidelines for the types of treatments that qualify for reimbursement. Some may cover only a percentage of your treatment, or cover only certain treatments.

Once your dentist has recommended a treatment plan, your first question will probably be: “will my insurance cover this?” It’s a question that often doesn’t have a simple answer (other than “maybe”). Whether a treatment is covered depends completely on the nature of the plan your employer has chosen. Some companies pay for plans that cover virtually everything, while others are more restricted. When purchasing a plan, your employer decides what services are covered, the percentage of treatment they will pay for, and even the maximum number of appointments you can have in a given time period.

However, no matter what the coverage, there’s one thing to remember. Insurance companies are in business to make money, not to make people healthier, and are far more likely to encourage people to opt for less expensive treatments. It may be better for you, for example, to replace a missing tooth with a dental implant than to construct a bridge. An implant is a more permanent solution, and for many patients, it can offer the most natural-looking result. But because a bridge is a less costly alternative, many insurance companies will not cover an implant.

If you’ve ever been denied coverage for something your dentist has recommended, you’re certainly not alone. It’s confusing – and many patients end up feeling concerned that their dentist is recommending an “unnecessary” procedure. However, please remember that if an insurance company denies coverage, it is not making a clinical decision. It is making a financial one. It isn’t telling you that the treatment isn’t necessary or beneficial, but that it is not included in the benefit plan your employer has chosen for you.

It is the role of your dentist to offer you a full range of choices that will help you feel good, look good, and will last in the long term. He or she can present you with strategies that focus on your optimal health – and not simply on an insurance company’s bottom line.

So rather than just asking “Will my insurance cover this?” I ask my patients to consider the bigger picture, and pose this question instead: “If my insurance can’t cover this, what can I do to still get the best, healthiest result?” Most dental practices (including ours) offer flexible financial arrangements to help you manage your payments. Options can include post-dated cheques or credit card payments or third-party financing.

For example, our office is partnered with HealthSmart Financial, a company that offers flexible, 0% financing for most procedures, even those not covered by dental plans. You can pay for a portion of the treatment yourself and get a loan for the rest, negotiate affordable monthly payments, and if you want, you can even pay it off before the term ends. (Unlike many other loans, there are no pre-payment penalties.)

So if your dentist recommends a treatment your insurance won’t cover – or if you don’t have health benefits at all – there are manageable ways make that important investment in a healthy, beautiful smile.

If you have questions about health insurance, payment options, or anything else in our blog, please feel free to contact us anytime at 905 637-5463 (KIND) or drop us an email at info@desiredsmiles.com. We’d love to hear from you.

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