Direct Billing Dentist in Aurora

What dentist direct billing means

Direct billing is a plain name for something insurers call assignment of benefits. You sign a form that lets your plan pay the dental office instead of paying you. We then send the claim electronically, and the plan sends its portion to us.

Without assignment, you would pay the full bill at the visit and wait for your insurer to reimburse you. The Ontario Dental Association explains both methods on its website. Some plans don't allow assignment, so it helps to check your plan booklet. As a dentist that direct bills all insurance plans, we will tell you if your plan works differently.

What you may still pay

Direct billing changes who pays first. It doesn't change what your plan covers. Most plans pay a set share of each service, and the rest is yours. This share is called co-insurance or a co-payment. The Canadian Dental Association notes that plans often cover routine care at a higher rate than major work, such as crowns or bridges.

Other plan rules can also leave a balance:

• A deductible: an amount you pay each year before the plan starts paying
• A yearly maximum: once the plan has paid its limit, the rest is yours until it resets
• Frequency limits: for example, how often the plan pays for X-rays or cleanings
• Fee differences: some plans base payment on an older fee guide, so they may pay less than the office fee

Why we can't waive your share

Sometimes patients ask whether the office can skip the co-payment. We can't. The claim lists the services and the full fee, and your insurer pays its share based on that total. The Canadian Dental Association states that waiving a co-payment is insurance fraud.

What we can do is make your share clear. After your exam, you get a written estimate that lists each service, the fee and what your plan is likely to pay. We'll explain your payment options before treatment.

Predeterminations for larger treatment

For crowns, root canals, dentures and other bigger work, we can send a predetermination first. This is a request to your plan, before treatment, asking what it expects to pay. The reply helps you plan.

A predetermination is not a promise. The Ontario Dental Association points out that it does not confirm the treatment will be covered. Your yearly maximum and other plan limits still apply when the real claim goes in. The decision about treatment stays between you and your dentist.

Two plans? We send both claims

If you are covered by your own plan and a spouse's or parent's plan, tell us about both. We send the claims in the right order so each plan can pay its part. Bring the details for both plans to your first visit, including the plan holder's name and date of birth.

CDCP and IFHP billing

We bill the Canadian Dental Care Plan (CDCP) through Sun Life, which processes claims for the federal government. Canada.ca says CDCP clients cannot claim costs back from Sun Life themselves, and they should not be asked to pay the full cost upfront. You pay only your co-payment, if you have one, plus any amount above the CDCP fee that we have shown you in writing. Some services need preauthorization from the plan before treatment, and we request it for you.

We also bill the Interim Federal Health Program (IFHP) for eligible refugees and asylum claimants. IFHP dental care now has a co-payment that you pay at the visit. Our refugee dental services guide explains what to bring and how coverage works.

What to bring for direct billing

Having the right details ready means we can check your coverage and send claims without delay.

• Your insurance company name, group or policy number and your member or certificate ID
• The plan holder's name and date of birth, if the plan is through someone else
• Your CDCP member ID, or your IFHP eligibility document and client ID
• Any second plan you are covered by

How it works at our clinic

1. Share your plan detailsSend us your insurance, CDCP or IFHP details when you book.
2. Exam and estimateYour dentist explains your options, and we give you a written estimate with your likely share.
3. Predetermination if usefulFor bigger treatment, we ask your plan what it expects to pay before you decide.
4. We send the claimAfter treatment, we bill your plan electronically. You pay only the part the plan doesn't cover.

Questions