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Dental Insurance Plans

Dental Fees

There may be a difference between the price your dentist may charge you and the amount covered by your dental plan. Here are three reasons why:

  1. Factors Considered When Calculating Costs
    The amount your dentist may charge you and the amount your dental plan may reimburse you for might be different because these two prices are not derived in the same way.

    When your employer and insurance carrier determine the amount of money your dental plan will pay for services covered under the plan, they take into account the specific circumstances of your company and its employees.

    They consider such factors as company funds available for employee benefits, the nature and extent of use of the dental plan by the employees, and which version of MDA Suggested Fee Guide for General Practitioners is used by the insurance carrier.

    The MDA fee guide is a reference of suggested fees for dental services that is updated annually by the Manitoba Dental Association. Some employers may use a current issue of the guide, while others may use past issues of the guide.

    On the other hand, every dentist sets his or her own fees, considering the factors affecting both the practice and the patients served. The MDA Suggested Fee Guide helps dentists derive fees, but this is only a guide and the fees are only “suggested”.

    A dentist may use this guide to formulate a fee for their dental services. Once a dentist has established a fee for a certain service, with special exceptions, he/she will charge that fee to all patients, regardless of whether or not the patient has a dental plan.

  2. The Plan Design
    For some dental services, payment may be based on a cost-sharing arrangement between the employer and the employee. In these cases, the patient pays for a portion of the cost, while the plan pays for the remainder.

    As identified on the claim form you sign after you receive a service, you are responsible for the bill. This means you are also responsible to pay for the portion of the bill not covered by your plan - the portion known as the co-payment.

  3. Individual Circumstances of the Patient
    If your dental problem is harder to resolve and requires more time or work by the dentist, the fee may be higher than the usual fee. Similarly, if the problem is less complicated and requires less time to work to resolve, the fee may be lower than what the dentist would normally charge.

    In some cases, financial concerns can make patients reluctant to see the dentist even when a problem is painful or in urgent need of treatment. For example, a toothache that might seem like it can wait could turn into an oral infection if not treated in time. For patients with poor overall health, especially those with heart disease, this could have serious consequences that might have been preventable with early treatment.

    In this type of situation, you should talk to your dentist. The best solution might be one where you work out financial terms and discuss all possible solutions, rather than waiting for an unresolved problem to get worse.