Overview
Before you seek dental services, it’s important to think about the dental expenses or how you’ll pay for those services. At The Little Green Building, we accept all dental insurance. But how exactly does dental insurance work in Ontario?
Dental Claim Submission Process
If you have private dental insurance, for example from your employer, and you seek dental services that are covered, you’ll need to make payment and submit your dental claim after your dental appointment. You can submit dental claims in three main ways:
- Direct submission and payment: You can submit your own claim and have the dental insurance policy pay you directly
- The dentist can submit your dental claim for you and then you are paid
- Dental assignment: You can assign your benefits to your dentist and they get paid directly
While a patient can choose any option they wish, dental assignment is not always allowed by the insurance company. In that case, only the first two options are available.
Dental Assignment of the benefits
Dental assignment is common practice of many dental insurance plans in Canada, but not all dental offices accept it. At the Little Green Building we accept assignment of benefits, which simply means your insurance carrier will pay us directly, and you are only responsible for the difference, if any.
How Does Dental Assignment Work?
Patients simply need to provide their benefits card and/or benefit plan number. Any fees that aren’t covered by a dental plan are paid by a patient.
It’s worth noting that some dental plans may not allow dental assignments. In such cases, you will be paid directly as opposed to your dentist being paid directly.
Benefits of Dental Assignment
1. Simple and Convenient Billing Process
Dental assignments simplify the dental billing process for both patients and dentists. After a dental appointment, your dentist takes over and submits your claim on your behalf and gets paid directly. The process eliminates the need for patients to file claims and wait to get reimbursed.
2. Lower Out-Of-Pocket Dental Expenses
Patients also pay. They pay the portion of dental care that isn’t covered by the dental plan plus copayments/coinsurance amounts, if applicable.
3. Direct Dentist-Insurer Communication
Your dentist can talk directly with your dental insurance provider about dental coverage and payment. This offers advantages like quick communication on dental coverage and fast, direct resolution on payment matters.
Managing dental insurance claims has never been easier. The Little Green buildings offers this convenient option! Contact our dental office to find out if your dental insurance plan offers dental assignments and if it requires you to see dentists within a specific network.
You’ll also get advice on other related matters like coverage limits, coverage levels, or deductibles applicable (copayment or coinsurance) to ensure you know the exact amount of out-of-pocket costs you will face, if any.
I Don’t Have Private Dental Insurance: What Do I Do?
If you don’t have a private plan from your employer, you may qualify for the Canadian government-funded dental insurance plan dubbed CDCP (Canadian Dental Care Plan).
About Canadian Dental Care Plan (CDCP)
The CDCP is designed to offer affordable dental care services to eligible Canadians. This plan is part of the Canadian government’s programs for improving access to basic healthcare services for citizens.
What Dental Services Are Covered Under the CDCP?
If you are eligible, you can get dental coverage for the following:
- Basic dental procedures such as dental cleaning, dental filling, dental extraction, dental x-ray, etc.
- Preventive dental care services: dental check-ups, fluoride treatment, and dental sealants
- Some dental procedures like dental crowns, root canals, and dentures
Important: Some basic and major procedures and dental care services may not be covered under special circumstances. Find out when/if preventative care, cosmetic dentistry, and treatments for damaged teeth or broken teeth (requiring tooth removal services, and restorative procedures/orthodontic treatments) are covered.
Who Qualifies for CDCP Dental Coverage? What are the CDCP Eligibility Requirements?
To qualify for the CDCP, you must meet certain eligibility criteria:
- Age requirements: You must be 0-18 years old or a senior (over 65 years). Individuals with a valid 2023 disability tax credit also qualify irrespective of age.
- Family income requirements: Your household income needs to be below the threshold for low-income families in your territory or province.
- Private dental insurance requirement: What’s more, you shouldn’t have any private plans/coverage
Canadian Dental Care Plan Enrollment
If you meet the above requirements, you simply need to submit your application to a designated enrollment agency or online. You need proof of eligibility to be successful.
Find Private Dental Insurance and Government-sponsored CDCP at the Little Green Building in Toronto (Near Bloor West).
Contact us for CDCP enrollment and related queries. The Little Green Building is among the participating dentists that take patients eligible for dental insurance coverage under the CDCP.
Since CDCP covers only a portion of the regular and customary dentist’s fees,it’s important to find out any resulting out-of-pocket dental expenses that you may incur.
Call: 416-769-8135 for all dental health and dental insurance-related queries in Ontario. You can also email us at littlegreenbuilding@gmail.com or visit us in person (Google Maps – 265 Jane Street).
Ask about treatment options, CDCP waiting periods, coverage for dental surgeries or regular visits, dental treatment options covered, dental coverage for cosmetic procedures/restorative services, dental health insurance plans, actual dental care costs after insurance and other oral health care services.
