{"id":3920,"date":"2019-08-30T19:03:43","date_gmt":"2019-08-30T23:03:43","guid":{"rendered":"https:\/\/www.sierradental.ca\/?page_id=3920"},"modified":"2019-08-30T19:03:43","modified_gmt":"2019-08-30T23:03:43","slug":"understanding-dental-insurance","status":"publish","type":"page","link":"https:\/\/sierradental.ca\/airdrie\/new-patients\/understanding-dental-insurance\/","title":{"rendered":"Dental Insurance"},"content":{"rendered":"<div class=\"fusion-fullwidth fullwidth-box fusion-builder-row-1 fusion-flex-container nonhundred-percent-fullwidth non-hundred-percent-height-scrolling\" style=\"--awb-border-radius-top-left:0px;--awb-border-radius-top-right:0px;--awb-border-radius-bottom-right:0px;--awb-border-radius-bottom-left:0px;--awb-flex-wrap:wrap;\" ><div class=\"fusion-builder-row fusion-row fusion-flex-align-items-flex-start fusion-flex-content-wrap\" style=\"max-width:1497.6px;margin-left: calc(-4% \/ 2 );margin-right: calc(-4% \/ 2 );\"><div class=\"fusion-layout-column fusion_builder_column fusion-builder-column-0 fusion_builder_column_1_1 1_1 fusion-flex-column\" style=\"--awb-bg-size:cover;--awb-width-large:100%;--awb-margin-top-large:0px;--awb-spacing-right-large:1.92%;--awb-margin-bottom-large:0px;--awb-spacing-left-large:1.92%;--awb-width-medium:100%;--awb-spacing-right-medium:1.92%;--awb-spacing-left-medium:1.92%;--awb-width-small:100%;--awb-spacing-right-small:1.92%;--awb-spacing-left-small:1.92%;\"><div class=\"fusion-column-wrapper fusion-flex-justify-content-flex-start fusion-content-layout-column\"><div class=\"fusion-title title fusion-title-1 fusion-sep-none fusion-title-text fusion-title-size-two\" style=\"--awb-font-size:38px;\"><h2 class=\"fusion-title-heading title-heading-left fusion-responsive-typography-calculated\" style=\"margin:0;text-transform:none;font-size:1em;--fontSize:38;line-height:1.4;\">A Guide to Understanding Dental Insurance<\/h2><\/div><div class=\"fusion-text fusion-text-1\" style=\"--awb-text-transform:none;\"><p><img decoding=\"async\" class=\"size-medium wp-image-5711 alignright\" src=\"https:\/\/sierradental.ca\/airdrie\/wp-content\/uploads\/sites\/2\/2022\/01\/Guide-to-Alberta-Dental-Insurance-300x216.png\" alt=\"Guide to Alberta Dental Insurance\" width=\"300\" height=\"216\" srcset=\"https:\/\/sierradental.ca\/airdrie\/wp-content\/uploads\/sites\/3\/2022\/01\/Guide-to-Alberta-Dental-Insurance-200x144.png 200w, https:\/\/sierradental.ca\/airdrie\/wp-content\/uploads\/sites\/3\/2022\/01\/Guide-to-Alberta-Dental-Insurance-300x216.png 300w, https:\/\/sierradental.ca\/airdrie\/wp-content\/uploads\/sites\/3\/2022\/01\/Guide-to-Alberta-Dental-Insurance-400x288.png 400w, https:\/\/sierradental.ca\/airdrie\/wp-content\/uploads\/sites\/3\/2022\/01\/Guide-to-Alberta-Dental-Insurance-600x431.png 600w, https:\/\/sierradental.ca\/airdrie\/wp-content\/uploads\/sites\/3\/2022\/01\/Guide-to-Alberta-Dental-Insurance-768x552.png 768w, https:\/\/sierradental.ca\/airdrie\/wp-content\/uploads\/sites\/3\/2022\/01\/Guide-to-Alberta-Dental-Insurance-800x575.png 800w, https:\/\/sierradental.ca\/airdrie\/wp-content\/uploads\/sites\/3\/2022\/01\/Guide-to-Alberta-Dental-Insurance.png 918w\" sizes=\"(max-width: 300px) 100vw, 300px\" \/><\/p>\n<p>Understanding and having a dental plan in place can really ease the cost of regular checkups, cleanings, repairs, and extensive dental procedures.<\/p>\n<p>When it comes to maintaining your oral health without any financial coverage, you really do put your money where your mouth is!<\/p>\n<\/div><div class=\"fusion-separator fusion-full-width-sep\" style=\"align-self: center;margin-left: auto;margin-right: auto;width:100%;\"><div class=\"fusion-separator-border sep-single sep-solid\" style=\"--awb-height:20px;--awb-amount:20px;border-color:#f5f5f5;border-top-width:2px;\"><\/div><\/div>\n<div class=\"fusion-text fusion-text-2\" style=\"--awb-text-transform:none;\"><h3>Dental Insurance in Alberta<\/h3>\n<p>In Alberta, general Oral Health Care is not included in our Canadian Health Act (CHA).<\/p>\n<p>Many Albertans are provided healthcare through their employer or through a government-funded program, such as Senior\u2019s 101, Alberta Works or Child health Benefits.<\/p>\n<p>You can purchase a supplemental dental plan through a number of private health benefit providers. This is particularly useful if you have no existing employer-based health plan, are retired or self-employed.<\/p>\n<p>The key to understanding the difference between your Dental Plan and a Treatment Plan is crucial.<\/p>\n<p><strong>A Dental Plan<\/strong>\u00a0is 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.<\/p>\n<p><strong>A Treatment Plan<\/strong>\u00a0is 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.<\/p>\n<\/div><div class=\"fusion-separator fusion-full-width-sep\" style=\"align-self: center;margin-left: auto;margin-right: auto;width:100%;\"><div class=\"fusion-separator-border sep-single sep-solid\" style=\"--awb-height:20px;--awb-amount:20px;border-color:#f5f5f5;border-top-width:2px;\"><\/div><\/div>\n<div class=\"fusion-text fusion-text-3\" style=\"--awb-text-transform:none;\"><h3>What is Co-Payment?<\/h3>\n<p>Co-Payment (also known as co\u2013insurance) is the portion of the bill that is the patient\u2019s responsibility.<\/p>\n<p>Many dental plans have co-payments or in other words a portion of the claimed amount that will not be covered.<\/p>\n<p>Patients may be told that their plan covers 100 % however insurers often have a maximum payable amount that may be lower than the actual dentist\u2019s fee for the services rendered.<\/p>\n<\/div><div class=\"fusion-separator fusion-full-width-sep\" style=\"align-self: center;margin-left: auto;margin-right: auto;width:100%;\"><div class=\"fusion-separator-border sep-single sep-solid\" style=\"--awb-height:20px;--awb-amount:20px;border-color:#f5f5f5;border-top-width:2px;\"><\/div><\/div>\n<div class=\"fusion-text fusion-text-4\" style=\"--awb-text-transform:none;\"><div class=\" vc_custom_1595363861101\">\n<div id=\"text-block-9\" class=\"mk-text-block jupiter-donut- \">\n<h3>How Much Do I Have To Pay?<\/h3>\n<p>That will all depend on the plan you choose.<\/p>\n<p>There are many variations so it\u2019s always important to know your plan details.<\/p>\n<p>Some plans set annual deductibles, limit plan spending, cap dollar amounts, and limit the number of visits allowed in a benefit year.<\/p>\n<p>Dental plans often do not cover every dental procedure, however, for the basics including regular check-ups, x-rays, hygiene (cleaning), fillings, root canals and extractions will usually be partially paid out.<\/p>\n<p><strong>Minor Procedures<\/strong><\/p>\n<p>The ratio for insurance payments in minor procedures is typically 80% -20%.<\/p>\n<p>This means that an insurer is likely to pay about 80% of the treatment costs according to their own fee guide, leaving the 20 % an \u201cout of pocket \u201cexpense for the patient.<\/p>\n<p><strong>Major Procedures<\/strong><\/p>\n<p>For treatment deemed major, such as crowns and bridges the ratio is more likely to be 50% \u2013 50% of the insurer\u2019s fees.<\/p>\n<p>It is important to understand that the majority of dental clinics may be using their own fees for procedures and not the ones set by your insurance company, resulting in a higher co-payment for the patient.<\/p>\n<p><strong>Your Dental Clinic can also provide you with a predetermination of costs.<\/strong><\/p>\n<p>A predetermination is a request sent to your insurer asking for coverage and estimated reimbursement details.<\/p>\n<p>This gives the patient an idea of what will be covered and what will be \u201cout of pocket\u201d.<\/p>\n<p>However this 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 help you with.<\/p>\n<div class=\"clearboth\"><\/div>\n<\/div>\n<\/div>\n<div class=\" vc_custom_1595363887121\">\n<div id=\"text-block-10\" class=\"mk-text-block jupiter-donut- \">\n<div class=\"fusion-title title fusion-title-size-four\">\n<h4 class=\"title-heading-left\">CAN MY DENTIST WAIVE MY CO-PAYMENT?<\/h4>\n<\/div>\n<div class=\"fusion-text\">\n<p>No. Any waiving of patient portions is insurance fraud and is against the law.<\/p>\n<p>Your dentist can be heavily fined for this or even lose their license.<\/p>\n<p>When you and your dentist sign the claim form that goes to the insurance company, you are stating which services were provided and how much, in total, was charged.<\/p>\n<p>The insurance company pays its share based upon the assumption that you will do the same.<\/p>\n<\/div>\n<div class=\"fusion-title title fusion-title-size-four\">\n<h4 class=\"title-heading-left\">WHAT IS DIRECT BILLING?<\/h4>\n<\/div>\n<div class=\"fusion-text\">\n<p>Direct billing occurs when your Dental provider sends their bills straight to the insurance company for payment, rather than having the patient receive the bill and file the claim.<\/p>\n<p>This eliminates the need for the patient to handle the initial interaction with the insurance company.<\/p>\n<p>However, it doesn\u2019t eliminate the need for a patient to pay costs that aren\u2019t covered by his insurance agreement.<\/p>\n<\/div>\n<div class=\"fusion-title title fusion-title-size-four\">\n<h4 class=\"title-heading-left\">YOUR DENTIST\u2019S ROLE<\/h4>\n<\/div>\n<div class=\"fusion-text\">\n<p>The first advantage a dentist provides is being able to give a forecasted dental treatment proposal.<\/p>\n<p>This way everyone knows what the next step will be and can work together with your insurance company to manage your dental goals.<\/p>\n<p>Ultimately your Dentist treats patients and not dental plans.<\/p>\n<\/div>\n<div class=\"fusion-title title fusion-title-size-four\">\n<h4 class=\"title-heading-left\">QUESTIONS TO ASK YOUR INSURANCE PROVIDER<\/h4>\n<\/div>\n<div class=\"fusion-text\">\n<p>It is strongly suggested to contact your dental insurer and ask these questions.<\/p>\n<p>This will give you more knowledge when making decisions about your treatment when at your dentist\u2019s office, as well as helping the dental team treatment plan what will work for you.<\/p>\n<p>Unfortunately, the majority of insurers do not allow anyone but the insured themselves to call and request any information on your plan.<\/p>\n<ul>\n<li>What is my benefit year? \u2013 Does it run annually or mid-year? Jan \u2013 Dec for example.<\/li>\n<li>Do I have a deductible?<\/li>\n<li>What is my maximum dollar amount for my benefit year? Does this include both minor and major procedures or do I have a separate maximum for both?<\/li>\n<li>What is the percentage covered for my minor procedures?<\/li>\n<li>What are the percentages covered for my major procedures?<\/li>\n<li>What are my frequencies for my checkups and cleanings? Can I come every 6, 9 or 12 months?<\/li>\n<li>How many units of scaling (removing the plaque) do I have to use in my benefit year?<\/li>\n<li>Do I get fluoride? Is there an age restriction?<\/li>\n<li>Do I have any Orthodontic coverage?<\/li>\n<\/ul>\n<\/div>\n<div class=\"fusion-text\">\n<p>Please do not hesitate to call our clinic and speak to one of our administrators.<\/p>\n<p>All of our Sierra Dental staff are fluent in insurance and are happy to help.<\/p>\n<p>If we do not know the answers we will find them for you.<\/p>\n<p>We also offer\u00a0<strong>direct billing<\/strong>,\u00a0<strong>predeterminations of treatments<\/strong>, and\u00a0<strong>financial arrangements<\/strong>\u00a0to all our patients to ensure smooth and easy payment transactions.<\/p>\n<\/div>\n<\/div>\n<\/div>\n<\/div><\/div><\/div><\/div><\/div>\n","protected":false},"excerpt":{"rendered":"","protected":false},"author":1,"featured_media":0,"parent":860,"menu_order":7,"comment_status":"closed","ping_status":"closed","template":"","meta":{"_acf_changed":false,"footnotes":""},"class_list":["post-3920","page","type-page","status-publish","hentry"],"acf":[],"yoast_head":"<!-- This site is optimized with the Yoast SEO plugin v27.4 - https:\/\/yoast.com\/product\/yoast-seo-wordpress\/ -->\n<title>Dental Insurance | Sierra Dental<\/title>\n<meta name=\"robots\" content=\"index, follow, max-snippet:-1, max-image-preview:large, max-video-preview:-1\" \/>\n<link rel=\"canonical\" href=\"https:\/\/sierradental.ca\/airdrie\/new-patients\/understanding-dental-insurance\/\" \/>\n<meta property=\"og:locale\" content=\"en_US\" \/>\n<meta property=\"og:type\" content=\"article\" \/>\n<meta property=\"og:title\" content=\"Dental Insurance | Sierra Dental\" 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