Direct Insurance Billing Dentist Calgary

Direct Insurance Billing

"Great office, and amazing staff that provides exceptional customer service. Pam that works the front desk went above and beyond in answering my questions and following up with me. All around great experience."

-Monique Lafaut,

Affordable dental treatments in Calgary

At Macleod Trail Dental we are committed to providing our patients with personalized, high-quality treatments at affordable prices. We follow the Alberta Fee Guide for all of our dental services. Please note that, due to our expertise, our dental costs may differ slightly from the fee guide. We do our very best to ensure smooth and easy payment transactions for all of our patients. Our computerized insurance system allows us to store insurance information and submit claims electronically or by forms. Our office is able to direct bill ALL insurance plans. For more information on insurance billing or if you have any questions/concerns, please feel free to give us a call anytime at 403-253-1248 or email us at [email protected].

How does direct billing work?

If you have insurance coverage, we will enter it into our computerized system. At the end of the appointment, we will send your electronic bill directly to your insurance company for payment rather than giving you the dental cost breakdown and the hassle that comes with filing the claim yourself. Typically, the insurance company will pay us the appropriate dental procedure costs and we will collect the difference (those costs that aren’t covered by your insurance agreement) from you.

Our office prides itself on providing a very high standard of dental care at a fair price. We are transparent with our billing as we don’t want to spring any surprises on our patients. After your first visit, you can expect to receive a clear, detailed estimate of your dental costs which includes a price quote for recommended procedures, so you can make a clear and informed decision on how to proceed with your treatment.

At your appointment, we will submit a claim to your Insurance Company and only charge you for the portion which is not covered by Insurance. We accept all insurance plans; private, employee, as well as government coverage such as Provincial Health Benefits including, Child Health Benefits, AISH, Seniors ABC and AHC, as well as Veterans Coverage and NIHB (First Nations Dental Coverage).

Financial Policy

Our computerized insurance system allows us to store insurance information, and submit claims electronically or by forms. Our office is able to direct bill most insurance plans.
We assist our patients with understanding and utilizing their insurance coverage. Dental insurance is a very complex subject; while it is not possible for us to know every detail, limit, or exclusion involved in all the plans we deal with, we endeavour to assist you in navigating your insurance coverage.
Unlike other Provinces, Alberta does not have a set dental fee guide. Thus the Insurance companies each have their own fee guide, such that there is no standard or universal fee schedule.
Our office prides itself on providing a very high standard of dental care at a fair price.
We can submit treatment plans to insurance companies to pre-state coverage available.
Payment plans may also be established prior to treatment. Our office accepts assigned insurance proceeds, cheques, Visa, MasterCard, American Express and debit.

Common Insurance Terms

Maximum: Many insurance plans have a dollar maximum. The coverage period is either the policy year or the calendar year. The plan may specify a separate maximum for basic treatment and for major treatment (crown and bridge, dentures.) Often the maximum is combined.

Coverage Year: Coverage may be based on a policy year or on a calendar year.

Deductible: Some insurance plans have a deductible, which is a dollar amount which the insured must pay before the Insurance Company pays the claim. A deductible may be per individual or per family.

Fee Guide: There is no longer a standard fee guide in Alberta. Each Insurance Company sets its own fee guide and will pay claims as a percentage of that rate. Some Insurance Companies, such as Alberta Blue Cross, have several fee guides. Dental offices set their own fee guide and according to the Alberta Dental Association’s professional standards, may not vary that fee guide between patients or insurance plans. Thus, even when a plan states that it provides 100% coverage, the coverage rate may be based on the Insurance Company’s fee schedule and not that of the dental office.

Co-Insurance: The patient co-insurance is the percentage of the Insurance Company fee guide which is payable by the patient. If the coverage is at 100%, the patient is responsible for the difference in the fee guides, if any. If the coverage is at 80%, the patient pays the 20% as well as any fee guide difference.

Frequency Limitations: Your plan may limit the frequency of exams, tooth polishing, fluoride and x-rays.

Dental Cleaning Limitations: If you are advised to have dental cleanings in excess of the exam and polishing limitations, you are likely still covered for the very important scaling or rootplaning component of these appointments.

Scaling, the removal of subgingival plaque, is measured in 15-minute intervals. Typically Insurance plans provide for 8 to 12 units per calendar or policy year and may be on a revolving basis. Generally, a cleaning appointment is 3 to 4 units of scaling (45 to 60 minutes), such that 12 units would allow for either 3 or 4 cleaning appointments per coverage year. Exams and polishes are thus scheduled in compliance with the Insurance terms, and not done at each cleaning appointment.

Insurance Coverage

Many employers offer insurance coverage to their employees as part of a group insurance plan. If you are not covered under a group dental insurance plan, you may consider purchasing individual dental coverage. Individual plans are offered through many insurance companies, including Alberta Blue Cross and Manulife. In addition, organizations such as the Alberta Motor Association and Chambers of Commerce offer both group and individual coverage.