How to Bill Medical Insurance for Dental Procedures?

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If you have a group or private insurance for your dental care, you probably want your clinic to contact the insurer to obtain reimbursement on your behalf. This is called “payment delegation”. For you, this avoids having to pay the total amount of care during your appointment and having to make the claim online or by mail after the appointment.

But by the way, does it start? Do all clinics offer this service? Do all insurers accept this kind of arrangement? Does your contract allow it? Answers to your questions here:

NOT ALL DENTAL CLINICS ACCEPT CLAIMS FROM YOUR INSURER ON YOUR BEHALF.

If you are currently shopping for a new dental clinic, following a move, for example, be aware that not all clinics offer insurance claims services on your behalf.

You should know that delegation of the dental payment procedure is a procedure that the Order of Dentists would very much like to abolish in the coming years, for several reasons:

  • this gives too much power to insurers, in the sense that they are the ones who decide which treatments are covered and which are not, which distorts the patient’s decision-making in the treatments he wishes to receive;
  • for the dentist, it often happens that his recommendations are not followed for a question of insurance, whereas the only desire of the professional is to offer the best care for the good of the patient;
  • dentists often have to wait several weeks before being reimbursed by insurers for treatments already rendered.

In short, it is a service offered by the clinic, not an obligation.

For the moment, however, the procedure still exists and according to your preference, you can choose a dental center that settles everything on your behalf in order to facilitate your task and avoid disbursing your entire bill at each visit. As a patient, however, you are responsible for knowing the details and terms of your coverage.

(To answer the question you probably have in mind: Yes, the Mont-Saint-Hilaire Dental Center offers this service!)

However, there are other questions to ask…

DOES MY INSURER REIMBURSE MY DENTAL CARE DIRECTLY AT THE DENTIST?

Unfortunately, sometimes the answer is “no”. Although many insurers accept reimbursement directly at the dentist’s office, there are still a number of insurance companies that prefer the client to take the reimbursement steps. Sometimes this may be due to the absence of a computerized system allowing reimbursement in real-time, sometimes it is a question of verification measures that the insurer prefers to keep in its power.

Whatever the reason, it is often more difficult to change group insurance companies… But know that if we cannot offer you the service because of your insurer, you will always have the possibility of putting pressure on the latter so that he thinks about this possibility.

DOES MY INSURANCE CONTRACT ALLOW THE REIMBURSEMENT OF MY DENTAL CARE DIRECTLY AT THE DENTIST’S?

It is important to know that even if a company allows reimbursement in real-time on the spot, it is possible that your specific insurance contract does not allow it. During your first appointment, we will take the steps for you in order to attempt the first reimbursement. If it is refused and the company of which you are a customer usually accepts the procedure, it is because your specific contract does not allow it.

Once again, this is a situation beyond our control and you could take steps with the company that insures you to obtain a change to your group’s contract. It also sometimes happens that your contract is modified over the years and that a change in your favor occurs. Know what your contract says.

In short, rest assured (no pun intended!) that we will do everything we can to ensure that you obtain reimbursement on the spot during your dental care appointments. Our experienced team will be able to take all the steps to obtain reimbursement, but in the event of a refusal, you will have to work with your insurer to obtain your reimbursement.

By aamritri

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