How Dental Insurance works at our Mississauga Location

At Churchill Smiles Dentistry, we will electronically submit your claim to your insurance provider. To find out what you are covered for, we will even give you a free benefits check.

Once your appointment is over, you pay us, and we file your claim. Then you are paid back by your insurance carrier within a few working days!

Bonus: You can get reward points by using your rewards cards. Ultimately, the insurance provider reimburses you for your money within a few days, nevertheless.

As an example:

1. You complete your appointment, and it costs $100.

2. After receiving payment from you, we quickly electronically submit your claim to your insurance provider, saving you the trouble.

3. You will receive your $90 back in a few business days if your insurance provider pays 90%.

4. If your insurance company covers 100% of the cost, you won’t have to pay anything out of pocket and will receive your whole $100 back in a few business days!

A few patients ask us “Why don’t you send the insurance companies bills directly?”

The so-called “assignment dental offices” are doing this less and less. Even while it would seem more convenient for the patient, many dental offices are giving up on this approach due to costs, complex insurance programs, and privacy policies. Moving towards “non-assignment” is encouraged even by the Ontario Dental Association (ODA).

Why Assignment Is Opposed by the ODA?

The ODA actively encourages dental plan sponsors to create “non-assignment” dental plans since it opposes the assignment of benefits.

Why the ODA would reject a method that many find convenient is a question that many people have. The reason for this is that “non-assignment” dental plans may be less expensive than those that permit assignment because, in paying for their treatment, patients are essentially financing their own oral health care. This gives the patient a strong incentive to make sensible use of their dental plan.

Dental claim reimbursement is being processed far more quickly than it was in the past, and patients are finding that paying the dentist directly results in a prompt reimbursement check that reduces their out-of-pocket time. Thanks to electronic claims submission, it is not unusual to see the dentist on Monday and receive the reimbursement cheque by the end of the week. Furthermore, a lot of dentists use credit cards, which are usually billed every month. Dentists can set up a payment plan that enables patients to budget for costs and receive reimbursement at a more opportune time if sophisticated treatment is required.
Achieving outstanding oral health care requires patients to actively make decisions about their care as well as significant involvement in financial issues related to dental care, including the dental plan.

Source: https://www.oda.ca/visiting-the-dentist/dental-benefits/

Find out what coverage you have.

We are not allowed to find out what you are covered for due to the Privacy Act. To discover what coverage you have, we suggest you either get in touch with your insurance provider or refer to your company’s booklet.

Common questions and codes:

For new patients

1. New patient exam
01103: Complete oral exam (adult) or 01204: Specific exam
– Ask your insurance company if you are eligible for a complete oral exam.
– If they say “No”, ask them when you will be eligible and inquire about your eligibility for a specific exam.

2. Radiographs (X-Rays)
02112: periapical (checking root tips on upper and lower teeth)
02144: bitewing (to check for cavities in between teeth)
02601: panoramic film (full mouth view)
– Ask your insurance company if you are eligible now. If not, when?

For existing patients:

1. Cleaning
11111-11116: scaling and 43424: root planning
– Ask your insurance company: how many combined root planning and scaling units are allowed per benefit year?
– Are these units per benefit year, calendar year or rolling months?

2. Selfcare
13214 (1 hour): self-care or Oral Hygiene Instruction
Ask your insurance company: is this included in my plan?

3. Maximums
Ask your insurance company:
– What is your yearly maximum?
– When does my benefit year begin and end?

If you do not have insurance

Payment plans that “fit your budget” can help you achieve your goals, be it eating the foods you like or smiling like a movie star. Ask us about it right now!

You may be surprised to learn that most dental services are tax-free! Yes, there is no PST, GST, HST, or other ST! The only services that are subject to taxes are cosmetic services like whitening procedures.