Dental insurance benefits are used to help our patients cover some or all of the cost associated with their dental care. Not all dental insurance plans are the same which makes it important for you to understand your specific plan details before your appointment. Most dental plans cover some, but not all of the cost of your dental care. The dental fees billed at Parkview Dental for our services are the usual and customary fees charged to all our patients, whether you have dental insurance or not. Your particular policy may cover treatments and services at a fixed fee schedule, which typically does not coincide with our usual fees. In these cases, here the difference in fees not covered by your insurance company becomes your responsibility to pay and will be invoiced to you once we receive payment from your dental plan.
At Parkview Dental, help our patients maximize their dental insurance benefits, and we ask our patients to please bring along a copy of their plan details for us to help you get the most out of your dental insurance. We also use this information to provide you with accurate estimates for your treatment.
At Parkview Dental, we require payment for your estimated or exact patient portion on the day of service. For your convenience, we offer several payment options:
Q] Do you offer direct billing?
A] Yes, we do offer direct billing, also called assignment.
Q] What costs will my insurance company cover?
A] Due to privacy laws, we are not permitted to access any information on your behalf from your insurance provider, and as such, we are unable to know exactly what your dental benefits will pay. If you have a copy of your plan details, we encourage you to bring them along to your appointment. We will do our best to provide you with an estimated patient portion. Please note: it is the responsibility of the patient to know the details of their insurance plan and to inform us when changes occur to the plan, what is covered by the policy and who is covered under the policy.
Q] What factors do you consider when providing an estimate for treatment?
A] An estimate for your treatment is based on the most recent information that we have on file. If you’re concerned about exactly what costs you’ll be responsible for, simply ask about our ‘Pre-Determination.’
Q] What is a ‘Pre-Determination’?
A] A Pre-Determination provides you with the exact cost of the treatment. Upon request, we will submit this information to your insurance provider before completing any treatment. While this may delay your treatment, you will know exactly what [if any] out-of-pocket costs you may be required to pay.
Q] What payment options are available to me?
A] We require payment in full for your patient portion at the time of treatment. We accept MasterCard, Visa, American Express and Interac [Debit].
Q] What is the best way to budget for my treatment?
A] We’re happy to put together a detailed treatment plan with the associated costs outlined so that you can budget for each appointment accordingly. We can also prioritize treatments so that you can attend to the most urgent treatments right away and then plan further treatments over time.
Q] Do you extra bill over and above what my insurance company pays?
A] No – There is no set Dental Fee Guide in Alberta. The last established fee guide was published in 1997. Every dentist in Alberta is required to set their fee guide based on their education and training, skill, clinical judgment, and experience while taking into account the overhead practice costs. Each Benefit Provider also sets their fee guide, often having many different fee guides for their different policies. This is why it is difficult for us to give our patients the exact amount which will be their portion outside of what their benefits will pay. Some plans pay below our fee guide; some pay the same fees, and some would pay fees higher than our fee guide.
Q] My dental insurance said it pays 100% for my dental treatments: why do I still owe you money?
A] We hear this question often. Usually, the patient has looked at his EOB [explanation of benefits statement] which tells you what the provider paid, or they check their plan booklet and sees that the fee charged by the dentist exceeds the fee guide amount set by the Benefit Provider. The problem is that the fee covered by the provider is whatever has been negotiated between your employer and the Benefit Provider, and is directly dependent upon the premium paid for your specific benefit policy. That is why the coverage can vary even among the employees of the same company or other patients covered by the same Benefit Provider. [Also see “Do you extra bill up and over what our insurance company pays?”]