Payment always depends on the specific plan. Rules vary depending on coverage. In most instances, an 80/20 system exists. The plan covers 80 percent of the cost, and the patient is responsible for the rest. Basic care such as teeth cleanings, examinations, X-rays, and fillings are the most likely instances of the 80/20 rule. Some more involved procedures such as root canals also qualify.
Major dental work generally has an even split. Called a 50/50 plan, this type of coverage has the insurer pay half, and the patient pays the other half. Bridges, crowns, and other serious dental procedures are likely to have the 50/50 division of cost.
Canada also has specific laws involving dentistry. The person performing the procedure cannot waive the co-payment. It’s actually a federal crime, a kind of insurance fraud. If found guilty of this crime, your dentist is subject to large fines or loss of their license to practice.
To avoid such legal concerns, you and your dentist will sign a claim form. It states which services the dentist provided and the total cost of the dental care. This document goes to the insurer. In signing this agreement, the patient agrees to pay for their part of the coverage. After verifying the charges, the insurer agrees to pay their part, too.
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