- Administrative procedures at Streetsville Dental
- Health information and privacy in our office
- Dental insurance – general information
- You and your dental plan
- Dental plan co-payments, how do they work?
- My dental claim reimbursement was limited or declined. Where do I turn for help?
- What can I do to get the most out of my insurance benefits?
Administrative procedures at Streetsville Dental
Do you accept new patients?
Yes, we accept new patients on an on-going basis. Please call to make an Initial Exam appointment.
What should I bring when I come in?
If you are a new patient you will need to bring in:
- Driver’s License
- Insurance card if available
- Recent (past two years) ‘x-rays’ from your past dentist if available.
What is the cancellation policy?
In order to maintain an efficient and on-time schedule we request that our patients call at least 48 hours in advance to cancel an appointment. Broken Appointment charges are applied for two reasons:
- Patient is more than 20 minutes late for scheduled appointment without a valid reason
- Patient calls to cancel a scheduled appointment with less than 48 hours notice. Of course, there are exceptions with valid reasons. We will be more than happy to re-schedule appointments for you at a more convenient time.
What forms of payments do you accept?
We accept the following forms of payment: Cash/Cheque, Credit cards: American Express, MasterCard, Visa.
Privacy of your personal information is an important part of our office providing you with quality dental care. We understand the importance of protecting your personal information. We are committed to collecting, using and disclosing your personal information responsibly. We also try to be as open and transparent as possible about the way we handle your personal information. It is important to us to provide this service to our patients.
Our Privacy Information Officer is Dr. Timothy Lee and can be reached at:
2-117 Queen Street South, Mississauga, ON L5M 6B5
Dr. Timothy Lee will attempt to answer any questions or concerns that you might have.
If you do have a concern and/or wish to make a complaint to us about our privacy practices, including asking questions about the contents of your charts or records, you must make your request in writing. Please send it to our office’s Privacy Information Officer by surface mail, fax or e-mail. Our Privacy Information Officer will promptly acknowledge receipt of your complaint in writing, and will ensure that it is investigated thoroughly. You will be provided with a formal decision in writing, and the reason for the decision.
Our privacy policies and procedures comply with federal legislation called the Personal Information Protection and Electronic Documents Act (PIPEDA). This very complex law does provide for some exceptions to the privacy principles that are too detailed to outline here. The Personal Health Information Protection Act (PHIPA) outlines privacy policies and practices for health information custodians, for the protection of personal health information in the province of Ontario. As dentists, we follow the regulations outlined in PHIPA, which consider the needs of healthcare practitioners.
Our Privacy Code sets out this dental office’s commitment to protecting your private health and personal information. It is available on request by asking any of our office staff.
Please be assured that every staff person in our office is committed to ensuring that you receive the best quality dental care.
Health information and privacy in our office
Personal health information and privacy
Ontario has a law that protects your personal health information and how you can get access to it. You have the right to know how we may use and give out your personal health information and how you can get access to it. Please ask to see our Brochure and Privacy Statement for more details on our privacy practices.
Who can use and see your personal health information
Your personal health information must be kept private and secure. You or a person who can legally make decisions for you about your personal health information can use and see it. Your personal health information is shared among the people who provide you with health care. We may collect, use and give out your personal health information to others as reasonably necessary to:
- provide you with health care,
- communicate with or consult other health care providers for your health care,
- get payment for your health care from private insurance and
- report as required or permitted by law.
There are certain other circumstances where we may be required to give out some of your personal health information. If you want to know more, please see our Brochure or speak to us.
Your rights and choices
You or a person who can make decisions for you about your personal health information have the right:
- to see and get a copy of your personal health information;
- to ask us to make corrections to inaccurate or incomplete personal health information;
- to ask us not to give out your personal health information to other health care providers (we will not give out this information unless required or permitted by law to do so) and
- to be told if your personal health information is stolen, lost or improperly accessed.
There are certain exceptions to these rights – please see our Brochure for more information.
Who you can talk to about your decisions
Where you give us permission to use or give out your information, you may change your mind at any time. However, sometimes the law allows or requires us to give out your information without your permission. For more information, please see our Brochure.To make your choices, please speak to our contact person, Dr. Timothy Lee.
Other important information
We are required to keep your personal health information safe and secure. We will get your permission before we give out your personal health information to others:
- who want to offer you their products/services or
- for certain research projects where your consent is required.
Our Privacy Code sets out this dental office’s commitment to protecting your private health and personal information. It is available on request by asking any of our office staff.
How to reach us
If you have questions or concerns about our privacy practices, please speak to our contact person. Dr. Timothy Lee at 905-567-8899 or firstname.lastname@example.org
The Information and Privacy Commissioner of Ontario is responsible for making sure that privacy law is followed in Ontario. For more information about your privacy rights, or if you are not able to resolve a problem directly with us and wish to make a complaint, contact: Information and Privacy Commissioner of Ontario, 2 Boor Street East, Suite 1400, Toronto, Ontario, M4W 1A8; Toll Free: 1-800-387-0073; www.ipc.on.ca.
Dental insurance – general information
Dental insurance is a highly complex benefit that creates confusion for many dental patients. The complexities of dental insurance and the lack of sufficient information provided by some insurance companies make it very difficult for some patients to properly understand their benefits. Even more confusing is understanding how to properly work with your dental insurance company to achieve the highest level of benefits to which you are entitled.
What is dental insurance?
Dental insurance is a contract between you, your employer and your dental insurance company. The benefits that you receive are based on the terms of the contract that were negotiated between your employer and the dental insurance company and NOT your dental office. The goal of most dental insurance policies is to provide basic care for specific dental services. The services selected are based on the cost of the policy to your employer and the negotiated arrangements with the dental insurance company.
Because the benefits you currently have are decided between your employer and the insurance company, many services are not covered. The selection of non-covered services is not based on what you need or want, but is based strictly on the contract with the insurance company. Dental insurance companies rarely cover 100 percent of any dental fee and, in many cases, cover 50 percent or nothing at all. Also, most dental insurance plans have a dollar amount limitation each year. Once this limit is reached, no other services will be covered by your dental insurance company regardless how essential the service may be to your dental health.
Covered and non-covered services
Unfortunately, some of the services that you may need or want will not be covered by your dental insurer. Our goal is to help you achieve and maintain optimal dental care.
We do not want to compromise your care based on restraints placed by an insurance company.
Non-assignment of benefits
Since dental insurance is a contract between you, your employer and your dental insurance company, payment of benefits are assigned to you, NOT your dental office.. Therefore, we kindly ask for payment from you at the time of your scheduled appointment and your insurance company will reimburse you.
How our office helps
Our office will do everything possible to help you understand and make the most of your dental insurance benefits. Our office will electronically submit dental insurance forms to your insurance company to achieve the maximum reimbursement to which you are entitled as quickly as possible.
Many insurance companies require authorization for major procedures in advance. Our office will do everything possible to help you maximize the insurance benefits to which you are entitled. Patients need to understand that you are responsible for all fees not covered by your insurance company. Naturally, we always provide you with the full fees in advance of major treatment so that you know the exact cost.
Ask us for help any time
Anytime you have a question about your dental insurance, please feel free to ask us.
Our office remains dedicated to providing optimal care for every patient and working with you to achieve that goal. We pride ourselves on helping you in any way and in continuing to provide the quality of care to which you have become accustomed.
Please let us know if you have any questions – it would be our pleasure to help you.
You and your dental plan
Dental plans explained
Employers sponsor dental plans for a variety of reasons, including the promotion of good health, to keep their work force healthy and fit and to attract and retain top-notch employees. Your employer will provide you with details of your plan that are written in plain language (Benefits Booklet). It will provide a brief overview of the covered services, limitations and exclusions, co-insurances, maximums and the fee guide used to calculate benefits.
The employer enters into a dental plan contract with a third party that will act as the plan administrator. Dental plan contracts are lengthy, complex documents that define what services are covered and under what circumstances they are eligible for reimbursement. Some limitations such as frequency limitations (e.g., this service is covered once every three years) are easily understood while others are more complex (e.g., this service is covered only when there is evidence of recurrent decay or fracture). Dental plan administrators are contractually obligated to reimburse patients based upon the terms of the dental plan contract. This means that in some instances, necessary treatment may not be covered.
The patient’s responsibilities
There are more than 30,000 dental plan contracts in Ontario and each plan will be a little different from the next. You are the person responsible for understanding the details of your dental plan, furnishing the dental plan administrator with necessary information such as pre-treatment forms, claim forms or supplementary information such as x-rays and you are responsible for making arrangements for payment to your dentist for the dental care received.
The dentist’s responsibilities
The dentist, in accordance with the Regulated Health Professions Act and applicable regulations, will give you information on available treatment options appropriate to address your dental care needs, regardless of the nature and extent of your dental plan coverage. In addition, the dentist will assist you by supplying information required to enable you to receive any benefits to which you may be entitled under your dental plan.
How dentists help patients with their dental plans
Upon your request, your dentist will assist you by furnishing you with information that you need to enable you to receive benefits through your dental plan. This would include giving you claim and pre-treatment forms.
Sometimes additional information may be requested by your plan administrator in order to ensure that the treatment is eligible according to the terms of your dental plan. In such cases the plan administrator will write to you and ask you to obtain the information from your dentist. Your dentist will furnish you with any information you request but it is your responsibility to provide it to your dental plan administrator. This ensures that your health record remains confidential and your privacy is protected.
What will my dental plan administrator do with the information I submit?
Once your plan administrator has the necessary forms and any supplementary information requested it will be able to determine your plan’s liability based upon the provisions set out in the contract. You will be sent an explanation of how the benefit was calculated. All, some or none of your treatments may be covered or, for some services, coverage may be limited to an alternative, less expensive procedure. It is important to understand that necessary treatment and covered expenses are not the same things.
My reimbursement was limited or declined. Where do I turn for clarification?
First, read the explanation from your plan administrator carefully. In most cases, it will explain how the benefit was calculated and it will identify any limitations or exclusions that have been applied. Look for language such as “Under the terms of your dental plan..”, “Your plan limits coverage to..” and “These services are covered only when…”. These types of statements indicate that there are limitations within your contract and they have been applied to your claim and as a result some or all of the costs associated with your treatment will remain an out-of-pocket expense not reimbursable under your plan. For more detailed information about the specific provisions of your plan, you should consult your employee handbook, discuss the matter with your benefits department or speak directly to your plan administrator. The Advisory Services Department of The Ontario Dental Association is also able to provide you with assistance and advice 416.922.3900.
The last word
Dental plans are designed to assist patients pay for their dental treatment however not all dental treatments are eligible or fully reimbursable. If your dental treatment is only partially covered, you will have share in the cost of your dental care. Covered services and necessary treatment are not the same things.
Remember, you are a partner in your oral health and all treatment and care decisions should be made by you and your dentist based upon your actual needs, independent of your dental plan coverage. Your dental plan is not a treatment plan. Information courtesy of the ODA (www.oda.on.ca)
Dental plan co-payments, how do they work?
Many dental plans have co-payments, a percentage of the claim amount that is not covered by the dental plan. These co-payments are usually 20% – 50% of the claim amount. Many dental patients believe that the dentist can waive these amounts so that the patient doesn’t have to pay the money. This is not the case and the consequences for not making a reasonable attempt to collect the co-payment are very serious.
Under the Dentistry Act, 1991 (Regulated Health Professions Act) dentists are required to make a reasonable attempt to collect the co-payment portion of dental fees for which the patient has payment responsibility. The profession’s regulatory body, the Royal College of Dental Surgeons of Ontario (RCDSO), is responsible for ensuring dentists adhere to this requirement.
The dentist has a professional obligation to collect the co-payment. On some occasions, the dentist may run into difficulties doing so. On these occasions, the term “reasonable” should be assessed taking into account the circumstances of the situation.
This includes occasions when it is clear to the dentist that the patient cannot afford to pay the co-payment. The dentist may then decide to cease pursuing the collection. The following options are open to make sure that the dental plan administrator is not misled:
- citing the reasons why this decision has been made, the dentist can advise the dental plan administrator of the situation and obtain his or her consent in writing to cease attempting to collect the co-payment and
- also stating the reasons why, the dentist could advise the dental plan administrator that he or she does not intend to collect the co-payment, and that he or she will accept as full payment, the amount the plan administrator will pay under the plan.
In either of these scenarios, no attempts to mislead the dental plan administrator have been made. Intentional misrepresentation by the dentist can result in discipline by the RCDSO, loss or suspension of dental registration and criminal proceedings for insurance fraud. Insurance companies also reserve the right to request that the patient provide proof that the co-payment has been paid. If the patient is unable to provide that proof, the insurance company may demand the patient make financial restitution to the insurance company or it may apply the overpayment to future claims.
Clearly, waiving the co-payment and misleading the plan administrator jeopardizes everyone involved – the dentist, the plan administrator and the plan sponsor. Your dental plan is not a treatment plan. Information courtesy of the ODA (www.oda.on.ca)
My dental claim reimbursement was limited or declined. Where do I turn for help?
The explanation of benefits from your dental plan administrator, usually an insurance company, will explain how your benefit was calculated and it will identify any limitations or exclusions that have been applied.
Look for language such as “Under the terms of your dental plan.”, “Your plan limits coverage to.” and “These services are covered only when.”. These types of statements indicate that there are limitations within the contract and they have been applied to your claim. As a result, some or all of the costs associated with the treatment will remain an out-of-pocket expense not reimbursable under the plan. For more detailed information about the specific provisions of your dental plan you should refer to your employee handbook.
If you believe that your claim was declined incorrectly, the first place to turn to is the dental plan administrator. This will give you an opportunity to obtain clarification about its decision which will have been based on the contract that exists between the plan administrator and the plan sponsor, usually your employer. If you still have concerns then your next step is to discuss the matter with your employee benefits department. The Advisory Services Department of The Ontario Dental Association is also able to provide you with assistance and advice.
If after reviewing your information it appears that there is a problem related to the adjudication of your claim, we can contact the insurance company your behalf to request that your claim be reassessed. Please be sure to have the explanation of benefits from your plan administrator available as this document will contain the information that we need in order to provide assistance.
Dental plans are designed to assist patients pay for their dental treatment however not all dental treatments are eligible or fully reimbursable. If your dental treatment is only partially covered, you will have share in the cost of your dental care. Information courtesy of the ODA (www.oda.on.ca)
What can I do to get the most out of my insurance benefits?
Maximize your dental insurance benefits
You could save hundreds or even thousands of dollars by using your dental benefits before the end of the year. While some dental insurance plans run on a fiscal year, most run on a calendar year. If your dental insurance plan is a calendar year, then these 5 reasons will show you why you should make a dental appointment now.
The yearly maximum is the most money that the dental insurance plan will pay for your dental work within one full year. This amount varies by insurance company, but the average is around $1,000 per year, per person in your family. The yearly maximum usually renews every year (on January 1, if your plan is a calendar year). If you have unused benefits, you will lose them because they will not rollover to the next year, you will start over again.
The deductible is the amount of money you must pay to your dentist out of pocket before your insurance company will pay for any services. The amount of the deductible varies from one plan to another and could be higher if you choose an out of network dentist. However, the average deductible for a dental insurance company is $50 per year. You also have to meet the deductible again as the plan rolls over each calendar year.
If you are paying your dental insurance premiums by the month, you should be using your benefits. Even if you have healthy teeth and aren’t in need of dental treatment, you always should have your regular dental cleanings to help prevent and detect any early signs of cavities, gum disease, oral cancer and other dental problems that may exist. Most dental insurance companies pay 100% of the cost of your dental checkups that also includes all diagnostic x-rays and Doctors examination. Most insurance companies pay for their insured’s to visit their dentist two times per year for their routine checkups and examinations. Insurance companies have figured out that it saves them money for their insured’s to visit their dentist biannually because they catch problems when they are small rather than waiting for problems such as tooth aches, broken teeth, oral cancers and gum disease.
Another reason to use your dental benefits before the end of the year is possible fee increases. Some dentists raise their fees at the beginning of the New Year due to the increased cost of living, materials and equipment. A fee increase also can make your co-payment higher. Dental Problems Can Worsen – By delaying dental treatment, you are risking more extensive and expensive treatment down the road. What may be a simple cavity now, could turn into a root canal later and maybe even lead to tooth loss.