Dental Insurance & Financing FAQs
Dental Insurance in Nova Scotia
In Nova Scotia, general Oral Health Care is not included in our Canadian Health Act (CHA).
Many Nova Scotians are provided healthcare through their employer or children up to 15 have limited coverage through the MSI run Children’s Oral Health program.
You can purchase a supplemental dental plan through a number of private health benefit providers. This can be particularly useful if you have no existing employer-based health plan, are retired or self-employed.
The key to understanding the difference between your Dental Plan and a Treatment Plan is crucial.
A Dental Plan is an arrangement made between the patient and their insurer. The insurer sets the coverage and frequencies for treatment that is covered under the plan provisions.
A Treatment Plan is a planned treatment made by you and your Dentist. These plans are devised to meet your Oral Health goals but may not always be covered under your insurance provider.
Co-Payment is the portion of the bill that is the patient’s responsibility. Many dental plans have co-payments or in other words a portion of the claimed amount that will not be covered.
Patients may be told that their plan covers 100 % however insurers often have a maximum payable amount. Depending on each individual plan that maximum may be lower than the actual dentist’s fee for the services rendered. Our office follows the Nova Scotia Dental Fee Guide which is updated annually.
We require payment at time of service. If your treatment is spread out in multiple visits please inquire about financial arrangements prior to the appointment with the appropriate administrative staff. We accept cash, debit, MasterCard, Visa and American Express.
We are able to direct bill most insurance companies. There are some instances where insurance policies will not pay our office directly, which means you would pay us for services rendered, and your insurance company will reimburse you. We submit our insurance claims electronically, if you do have more than one insurance plan and depending on the service or amount it is required to leave a credit card on file for any outstanding balances.
Frequently Asked Questions
That will all depend on the plan you have. There are a variety of companies and a range of coverage so it’s always important to know your plan details.
Many plans set annual deductibles, limit the visits allowed per year and have annual or lifetime maximums.
Generally for the basics including regular check-ups, hygiene, x-rays, fillings, endodontics and extractions will usually be partially paid out. There will be times where your plan will not cover a service which is why it is beneficial to know the details of your coverage.
A predetermination is a request sent to your insurer asking for coverage and estimated reimbursement details for a specific procedure you and your dentist plan for.
This gives the patient an idea of what will be covered and what will be “out of pocket”. Most insurance companies send correspondence directly to the insured. Our office will help you understand your estimates, however, it is the responsibility of the patient to provide our office with the insurance response.
A predetermination is just an estimate and may differ when the time of treatment happens, it is a good resource to use when wanting to know what your benefits will cover.
Direct Billing is when the Dental office sends the bill straight to the insurance company for payment, rather than having the patient receive the bill and file the claim. Not all insurance policies allow for this, it is important to know if your plan has payment assignment.
This eliminates the need for the patient to handle the initial interaction with the insurance company. However, it doesn’t eliminate the need for a patient to pay costs that aren’t covered by their insurance policy.
The dentist provides a diagnosis along with an agreed upon dental treatment proposal. This way we can work together with your insurance company to manage your dental goals.
Our Dentist’s treat patients and are treatment based, not insurance based. We want to ensure we are providing the best oral healthcare possible, which can fall outside the limits of your policy.
Questions to ask your Insurance provider
It is suggested to contact your dental insurer or have the answers to these questions prior to your first visit with us.
This will give you more knowledge when making decisions about your treatment when at your dentist’s office.
Unfortunately, insurers do not allow anyone but the insured themselves to call and request any information on your plan due to privacy.
These will cover the basics, we will send in specific predeterminations to help find out some of the finer details of your policy, for individual treatment planning.