Question:
How do I manage dental expenses as a part of my benefit plan?
Answer:
For many people going to the dentist is their least favorite time of year. If you’re like me it’s because someone is prodding your gums for an hour, but for others it can be because of the expense at the end of a somewhat uncomfortable experience. Whether or not you have a benefit plan, most of us have experienced unanticipated costs. Between scaling, fillings, and x-rays, expenses can add up quickly. I have a few tips to help you be proactive about your dental fees, so you don’t face surprises at the end of your visit!
Does your Dentist charge to the Fee Guide?
The provincial Dental Association publishes a ‘recommended dental fee guide’ each year. Dentists and insurance companies use this guide to benchmark their fees and reimbursement levels for procedures. What most people would be surprised to learn is that dentists are not required to follow this fee guide and may charge above the guide for some or all procedures. Dentists are not like doctors who are pre-paid a fee by the government for their services, they are a business just like a lawyer or accountant and can set their own fee. It’s not common practice to talk to dental offices about their billing practices but wouldn’t you ask your accountant how much they charge prior to hiring them?
But why is it important to know if your dentist charges to the fee guide? Benefit plans will only reimburse employees up to the fee guide. Any expense above the fee guide will have to be paid out of pocket by the employee. Asking your dentist before your visit if they charge to the fee guide will help you determine the amount you’ll have to pay out of pocket at your visit.
Why is pre-authorization important?
Has a dental hygienist ever asked you “is fluoride covered on your benefit plan?” Most patients do not know what’s included in their benefit plan when it comes to routine cleanings, scaling, and x-rays. Which means, when it comes to the more advanced work and procedures like fillings or root canals, patients are usually in the dark about the cost of the procedure and the coverage they may or may not have.
This is why requesting pre-authorization is helpful. By providing your dentist with your insurance information and having them request an “estimate” from the insurance company, you will know in advance what is covered and what your portion of the expense will be prior to the work being done.
Make an informed Decision
While the treatment plan proposed by your dentist, and your decision to proceed with the recommendation, shouldn’t be based on the amount of insurance coverage: you should know exactly what your plan will reimburse and what you will need to pay out of pocket prior to your visit.
