Insurance FAQs
Your Insurance Questions Answered
At Dundas Dental Care, our goal is to ensure that you have a clear understanding of how your insurance works to make your experience with us as smooth and informed as possible that is why the team has compiled some of the commonly asked insurance related questions.
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Frequently Asked Questions
What is Direct Billing?
It means we send your claims electronically or manually for your insurance, however we can not send any mail to the secondary insurance unless we get a response from the primary.
What is a fee guide?
A fee guide is the price set yearly for the services provided by dental offices in Ontario by the Ontario Dental Association. Our office follows the current fee guide, although your insurance may cover a 100 % but if you are under a different fee guide than the current year, you are responsible to pay the difference out of pocket.
- Example: If your insurance covers 100% of 2020 fee guide, there will be a small balance not covered by insurance which is the difference in price between 2020 and the current fee guide that will be owing.
What is the difference between a claim acknowledgement, Explanation of benefits and Predeterminations?
- Explanation of Benefits: Insurance has received a claim and informed us how much of your claim is being covered and reasons why something is not being covered.
- Claim Acknowledgement: Insurance has received your claim but has not given us an explanation of what the coverage is and they are still processing it on your behalf.
- Predetermination: Estimate has been sent to your insurance for coverage details (This is not a claim this is for the office to ensure that your visit is covered before you receive your treatment).
Whose insurance comes first if you have multiple?
- Adult– Primary insurance (First) will always be your own (work or private). Secondary insurance will be your spouse or partner’s insurance.
- Children– The parent whose birthday comes first in the calendar year will always be primary insurance, whose birthday comes later in the year will be secondary for insurance purposes. In the instance your child has 3 insurances because of a step parent that insurance will be applied after going through biological mum and dad insurance.
What is assignment and non-assignment?
- Assignment is when you’ll pay the difference of what your insurance doesn’t cover.
- Non-Assignment is when you pay upfront to the office the day of your appointment and your insurance will reimburse you what it covers. We are a non – Assignment office
What is the difference between basic and major coverage?
Basic services are recalls, cleaning, root canal and extractions. Major services is for crowns, bridges, dentures. Usually basic coverage has different percentage coverage from major.
What is insurance max?
It is the amount of $ that you have available to use throughout your benefits year. It could be combined with basic and major or have a separate amount.
What is a benefit year?
A benefit year can start from January to December or September to August. However, you have it set up with your insurance company, the maximum restarts on that day.
What is deductible?
It is the first amount of money that your insurance company doesn’t pay. Example 50$ if you are single or 100$ if you are a family every benefit year.
