Insurance and Dentistry

Insurance and Dentistry

Patients have often posed questions to our staff about the insurance plans they have, and in particular, the shortcomings of these insurance plans.

Dental insurance is designed to reduce, not eliminate the fees that patients incur for dental services. Carte-blanche coverage is rare for dental insurance. Benefits are there to assist patients in payment rather than cover the payment completely. Insurance plans often are complex, and involve deductibles, exclusions, co-payments, annual maximum benefits for specific services, and other limitations. Most policies cover what they consider a "usual and customary fee." This is based on a particular schedule established annually by the Ontario Dental Association. The schedule of fees selected by the insurance companies is usually not the current year's schedule. Insurance is a bonus and a benefit to assist in payment for patients; it is not, and never was intended to be a pay-all situation.

The insurance benefit that a patient has is in direct proportion to what their employer has paid for that benefit. If more or better coverage is desired, it is advisable for patients to speak with their employer regarding this matter.

We find that many insurance companies provide the minimum standard of care for patients. The insurance plan is not a treatment plan. If the insurance does not pay for recognized dental procedures then the benefits are less than adequate.

>Choose another FAQ topic.