We often get phone calls to the office asking for fee quotes before we have even seen a patient for the first time. Obviously it’s hard for us to discern the exact nature of the problem and therefore the treatment that would be necessary. I think it’s important for people to understand the nature of how dentistry is billed in Ontario. Every year the Ontario Dental Association sends out it’s recommended fee schedule to every ODA member. In it are the fees for everything from examinations and x-rays to fillings, root canals and cosmetic work. Most of the fees are fixed per procedure, while others have a range, allowing dentists some flexibility to adjust for time spent and complexity. If a dentist is to charge above the fee guide (which we do not), the the dentist must inform the patient he/she is doing so. Insurance companies reimburse patients based on this fee guide. Whether you are reimbursed in full is a function of the insurance plan that has been chosen for you. You may not be insured at 100% for all procedures, you may have an annual deductible or you may be reimbursed at the fees for a fee guide that is outdated (by this I mean: The ODA fee guide increases it’s fees slightly year by year to keep up with inflation and other factors. if your plan reimburses you according to a fee guide of some years ago, it would amount to not being covered 100%).
I hope this helps a bit for those who don’t understand how offices bill. Remember, it is illegal for a dentist to not collect the balance owing by the patient. Insurance companies, and our regulating body. consider that a form of fraud.
– Dr. Jay Rabinovich