Q: How often can I get my teeth checked and cleaned?
A: These visits may consist of an examination, x-rays, scaling units, polish and fluoride. Dental insurance plans may cover some of these procedures every 6, 9, or 12 months. Scaling units however are independent of visits and are based on number of units per calendar or revolving year. Every person has an individual plan which outlines what the insured or their employer have purchased.

Q: How do I know what my insurance will cover?
A: First would be to check your benefits manual online, or if it is a group plan to consult with your HR department. When knowingly required by dental insurance companies our office will automatically submit a pre-determination on your behalf. This is usually done for services like crowns, night-guards and implants. As a courtesy however we will investigate insurance coverage on basic or routine services which are assumed covered when a question of coverage presents.

Q: Why if I have 100% coverage do I still have a balance?
A: The ADA+C have not prepared a regulated fee schedule for dental providers since 1997. Each dental office is permitted to set their fees. Additionally as “private” agencies, insurance companies are also permitted to set both the percentage of coverage for dental services they will pay but also potentially the amount of their own fee guide. Ever more confusing is in the case of group dental plans employers negotiate benefit coverage independent of their private plans. Hence, as a result of these variables a balance may occur even with 100% coverage.

Q: Why do I have to pay when I have two insurance plans?
A: At one time two insurance plans or “dual” coverage meant that clients would not be required to pay a balance if the services received were considered a covered benefit by both plans. However, over the past few years there has been an increasing trend where the second insurance company is choosing NOT to pay 100% of the balance that may remain but instead pay only the percentage of the balance that they would have paid if they were the primary insurer. EXAMPLE: 1 dental x-ray = $25.00 Primary insurance coverage paid 80% leaving a balance of $5.00 If the secondary insurance company follows this trend then if they too would pay 80% they would pay $4.00. This leaves their client owing $1.00.

Q: Why do fee differ from one dental practice to another?
A: As there is no provincially set fee schedule for Alberta dental offices, each office is permitted to set their own fees. At Lessard Dental we have chosen to follow the Alberta Blue Cross customary dentist fee guide released each calendar year. Your dental insurance coverage remains an agreement between yourself and your insurer therefore our fees are sometimes irrelevant.

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