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How Do I Know if Treatment is Covered Under My Dental Insurance Plan?

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Because most provincial insurance plans do not provide coverage for dental care, many Canadian residents choose to purchase individual dental insurance plans to help reduce their out-of-pocket costs for dental expenses.  However, many dentists do not accept payment directly from insurance carriers, leaving policyholders to submit claims to their insurance carrier for reimbursement.  This can leave patients wondering whether or not recommended treatment is covered under their dental insurance plan.

You should not make a decision about proceeding with a particular treatment based on whether or not your insurance plan covers it.  However, it is important to understand if your insurance carrier will pay for a particular service or if you will be responsible for payment.  This will let you plan financially, so you can minimize the impact to your bottom line.  Here are several ways to find out whether or not your dental insurance plan covers various treatments.

Read Your Policy

When you purchase a dental insurance plan, you will receive a complete policy that includes the products and services it covers as well as those that are excluded.  To find out if a particular treatment recommended by your dentist is covered under your plan, you can read your policy to find specific information about that treatment.

Contact Your Insurance Carrier

While you should be able to find many of the answers you’re looking for in the policy information, reading through it can be time consuming and even confusing.  If you have questions about specific treatments that are not listed in the documentation, you can contact your carrier directly.  Most insurance carriers have customer service lines set up specifically to answer questions from policyholders.  When you contact the claims department of your insurance carrier, a representative will be able to answer any questions you have about a particular treatment and whether or not it’s covered under your policy.

Ask Your Dentist to Contact Your Insurance Carrier

Your dentist may be willing to contact your insurance carrier on your behalf to find out if a treatment is covered under your dental insurance plan.  Many insurance companies have special lines set up to speak directly with dental care providers for the coordination of patient care, and many dentists are willing to contact insurance carriers on behalf of their patients.  This can be especially helpful if your dentist discovers the treatment they are recommending is not covered because they can speak with your carrier about other, equally effective treatments that are covered, which will help minimize your out-of-pocket expenses.

In addition, you or your dentist can submit a pre-treatment plan directly to your insurance company before treatment begins.  After submission of the plan, you will know exactly how much of the cost will be covered by your insurance carrier, so there are no surprises before your dentist starts the treatment.

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