Dental Insurance Assignment
(“Direct billing”)
As a service to our patients, we offer to collect the portion of their treatment that is covered by their private insurance plan, directly from that insurance company. This is referred to as “insurance assignment of benefits”. The vast majority of dental practitioners in Calgary are no longer accepting assignment of benefits due to the challenges it presents collecting from insurance companies and the confusion that may occur with the patient regarding services provided that may or may not be covered under individual plans. We have chosen to continue to accept direct payment from insurance companies as a service to our patients.
There are hundreds of different insurance companies in Canada and each of them have many different dental packages they sell to their clients. Each package has a different fee guide, as well as different percentage covered, deductibles, limitation, etc. For this reason, it is impossible for us to know the limitations and coverage provided by individual plans. While we will make every effort to help you to determine the insurance coverage that you have, ultimately it is your responsibility to know your plan.
Due to the Canadian Privacy Act in effect as of January 2004, most insurance companies will not release plan details or even verify active dental coverage to a dental office employee.
Your dental insurance is a contract between you, your employer and the insurance company, to assist you in the cost of dental treatment. They have designed the individual plan based on the type of coverage your employer has contracted, not on your individual dental needs. In this way, there may be significant differences between what your insurance provides coverage for, and treatment the dentist recommends for you.
We recommend treatment based solely on the patient’s needs, not on their insurance coverage. The treatment performed may not be covered and/or exceed your plan benefits. Ultimately, you are responsible for the costs of services provided.
Credit Card Policy
In order to “Direct Bill” your insurance company, we require a credit card on file for any outstanding amounts owing after your insurance plan has paid their portion.
Each insurance company has their own fee guide that they use to calculate your coverage. Insurances pay a percentage of their fee guide, not a percentage of our office’s fee guide. Because of this, it is impossible to estimate exactly how much you will be reimbursed by your insurance. We do however strive to get the most accurate estimate of reimbursement. On occasion, we will be able to charge you the exact amount on the day of your appointment. However, we often have to estimate your portion and because of this there may be a balance due after your insurance has paid us. We cannot send out statements for all these balances and this is when we will charge the balance owing to your credit card on file.
We will mail you a receipt, along with a copy of the Explanation of Benefits received from your insurance company for your records.
