Your dentist’s treatment recommendations are based on your dental health needs, not your dental plan.
According to the 2010 Canadian Health Measures Survey, 62% of Canadians have a pre-paid dental benefits plan, but many don’t realize that such group plans are not designed to meet individual dental health needs. Dental plans are a valuable component of extended health benefits and are designed to offset the cost of dental treatment. Understanding how dental plan benefits work can help patients make informed choices in partnership with their dentist or dental specialist.
Their treatment recommendations are based on your dental health needs, not your dental plan.
Your dentist or dental specialist is highly trained. Their treatment recommendations are based on your dental health needs, not your dental plan. Your dentist can help you understand your benefits and assist you in getting pre-determination of benefits for your treatment. This will provide you with an estimate of what will be covered by your plan, and what you will have to pay – before the treatment starts.
Dental office staff are not experts on your dental plan. It is your responsibility to know your plan benefits, including any changes. Ask your benefits manager or plan provider for a booklet or information on your specific coverage.
Coverage varies among dental plans
Your dental plan is part of your benefits plan, not based on your (or your family’s) dental needs. Every plan is different. Benefits vary based on what services are covered in the contract; percentage of fees covered for each service; and yearly maximums.
The plan purchaser, such as your union or employer, determines what is covered when they purchase your plan.
The co-payment (deductible)
Regardless of the actual costs, many dental plans cover between 50% and 80% of the cost of dental care. Any portion of the fee not covered by your plan must be paid by you, and is referred to as the co-payment.
Your dentist or dental specialist has an ethical and legal obligation to collect the co-payment from you.
As a convenience and a courtesy extended to trusted patients and reliable dental plan companies, some dental offices bill the dental plan directly for the covered portion of treatment. Dentists are not required to do this. The full cost of the procedure, including the co-payment, the deductible, and the cost of any services not covered by the plan, are the patient’s responsibility.
How are dental costs determined?
The Manitoba Dental Association produces an annual suggested fee guide for dentists and dental specialists in Manitoba.
Dentists in Manitoba are under no obligation to charge the suggested fees in the fee guide. Fees may vary based on the circumstances of the individual dental office and the treatment provided.
• Know your dental plan benefits and what is covered before your dental appointment to understand your portion of costs.
• Plan for the future. Consider all of your extended health costs when planning for your retirement.
• Discuss all treatment options with your dentist to make an informed decision based on your dental health needs. Understand any health risks associated with delaying or refusing treatment.
For more information, talk to your dentist or visit ManitobaDentist.ca.
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