Financial Policies & dental insurance
Welcome to Avenue Dental Centre – a private fee-for-service healthcare office committed to providing you with the very best that dentistry can offer in a comfortable, modern environment. This is an expensive on-going commitment. The payment policies of this office are designed to ensure that this practice operates smoothly and efficiently as well as allowing all patients to receive excellent dental care.
Each patient is responsible for his/her account with us and payment is required on the day of your appointment. If you have dental insurance, as a courtesy we will file your insurance for you at no additional charge and we will make every effort to assure you receive maximum benefits.
METHOD OF PAYMENT:
We accept Cash, Cheque, Debit, Amex, Mastercard and Visa.
FACTS ABOUT INSURANCE:
Fact 1 – Insurance is an arrangement between you and your insurance company
Fact 2 – No Insurance Pays 100% Of All Procedures
Dental insurance is meant to be an aid in receiving dental care. Many patients think that their insurance pays 90%-100% of all dental fees. This is not true! Most plans only pay between 50%-80% of the average total fee. Some pay more, some pay less. The percentage paid is usually determined by how much you or your employer has paid for coverage or the type of contract your employer has set up with the insurance company.
Insurance companies will release the amount they will pay for a procedure when the treatment is completed and the claim is submitted.
Fact 3 – Benefits Are Not Determined By Our Office
You may have noticed that sometimes your dental insurer reimburses you at a lower rate than the dentist’s actual fee. Frequently, insurance companies state that the reimbursement was reduced because your dentist’s fee has exceeded the amount allowed by your insurance company.
A statement such as this gives the impression that any fee greater than the amount paid by the insurance company is unreasonable or well above what most dentists in the area charge for a certain service. This can be very misleading and simply is not accurate.
The Ontario Dental Association (ODA) publishes a SUGGESTED FEE GUIDE. It is a guide and a reference only; as price setting is illegal. It merely represents an average cost for a procedure performed in the Province on Ontario.
Most insurance companies do not recognize the specialist fee. Instead, the insurance company will default to the General Practitioners fee guide to calculate reimbursement.
Unfortunately, insurance companies imply that your dentist is “overcharging” rather than say that they are “underpaying” or that their benefits are low
Fact 4 – Specialist FeeMost insurance companies do not recognize the specialist fee. Instead the insurance company will default to the Suggested General Practitioners fee guide to calculate reimbursement.
Fact 5 – Eligibility of CoverageMost insurance companies while determining their financial contribution to your oral health use the approach that could be described as coverage for the least expensive and ethically acceptable treatment. It means that some recommended treatments, such as implants may not be covered by insurance.
Fact 6 – Waiving the Dental Plan Co-Payment
Waiving the co-payment is actually against the law and considered insurance fraud.
By law, a claim to an insurance company must be an accurate description of services rendered and fees charged.
There is a plethora of information about dentistry that is available on the World Wide Web. However, not every site can be trusted. We have selected and created links to resources that are reliable and trusted.
The following two links connect you to the licensing authorities in the province of Ontario.
Professional Associations & educational resources
The links below will guide you to the Canadian (CDA) and American Dental Associations (ADA). Both of those sites have excellent educational material for dental patients. To further and expand on the topics you would like to explore more thoroughly we provided links to the sites of all recognized by CDA and ADA dental specialties.
Topics related to dental implants are widely covered on the net. The sites of the leading dental implant manufacturers are great resources for educational material.