Dental insurance benefits are used to help our patients cover some or all of the cost associated with their dental care. At Point McKay Dental, we offer the convenience of direct billing to your insurance. Not all dental insurance plans are the same which makes it important for you to understand your specific plan details before your appointment with us. Most dental plans cover some, but not all of the cost of your dental care. The dental fees billed at Point McKay Dental for our services are the usual and customary fees charged to all our patients, whether you have dental insurance or not. Your specific policy may cover treatments and services at a fixed fee schedule, which typically does not coincide with our usual fees. In these cases, 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 Point McKay Dental, help our patients maximize their dental insurance benefits and we ask our patients
to please bring along a copy of their plan details in order 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 Point McKay 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] Point McKay Dental offers the convenience of direct billing, as long as the policyholders Benefit Provider allows for direct billing. In some cases, we will not accept the assignment of benefits if these is a balance on account your account or a history of account issues. Also, these are some insurance policies that will not allow the benefits to be assigned to the dental office and will only forward their payment to the policy holder. In this case, we require payment for your dental services at the time of treatment
Q] What costs will my insurance company cover?
A] We are unable to know exactly what your dental benefits will pay. However, we will do our best to provide you with an estimated patient portion. 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.
Due to privacy laws, we are not permitted to access any information on your behalf from your insurance provider. If you have your plan details, please bring them along to your appointment.
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 PreDetermination provides you 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, 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 clearly 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 future treatments over time.
Q] Do you extra bill over and above what my insurance company pays?
A] No – Since there is no set Dental Fee Guide in Alberta and the last established fee guide was published in 1997. Every dentist in Alberta is required to set their own fee guide based on their education and training, skill, clinical judgment and experience while taking into account the practice overhead costs. Each Benefit Provider also sets their own 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 between 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?”]