780 476 3188, 211 Londonderry Mall, Edmonton, AB

Financial Information

Insurance FAQs

Your insurance policy is a contract between you (the beneficiary), your employer (the subscriber), and the insurance provider. As a service provider, Londonderry Dental Centre II is not a legislated partner in this contract – you are ultimately responsible for your account balance.

Contact your insurance provider for a comprehensive description of covered services, fee schedules, deductibles, and claim processes. Knowing your insurance policy will help eliminate surprises with payments and reimbursements.

Fee Schedule

Every dental office determines a fee schedule outlining the fees charged for specific services. We have determined our fee structure by considering the professional guidelines set out by the Alberta Dental Association and specific information related to operating this office. These fees are the same for all patients in our office.

Every insurance provider also determines a fee schedule outlining the maximum they will pay for specific services. Most insurance providers base their fee schedule on information published in the Alberta Dental Association Guide (1997).

If the fee schedule for Londonderry Dental Centre II is different than the fee schedule(s) used by your insurance provider(s), you are responsible for the balance owing.

Frequently Asked Questions – Insurance

  1. My insurance company pays 80%. Can you write off or adjust the balance so I don’t have to pay anything?
  2. Can you directly bill my insurance company?
  3. I have insurance coverage. Why do I have to pay up front?
  4. Can you get my insurance information for me?
  5. I am covered by more than one insurance policy (a primary and a secondary). Why do I still have to pay?
  6. Can you tell me specifically what will or will not be covered?
  7. Why do you provide/offer procedures that are not covered?

My insurance company pays 80%. Can you write off or adjust the balance so I don’t have to pay anything?

No, Londonderry Dental Centre II cannot write off or adjust the amount charged for services provided for two reasons.

We have determined our fee structure by considering the professional guidelines set out by the Alberta Dental Association and specific information related to operating this office. These fees are the same for all patients, regardless of insurance considerations. If we could adjust fees and still remain economically viable, we would do so for all patients, not just insurance subscribers.

Many insurance companies use a co-payment plan where part of the dental fee is covered by the insurance company and part is covered by the patient. Through these plans, the patient is legally liable for his/her portion of the fee. Writing off or adjusting the fee means the insurance company assumes responsibility for a higher percentage of the total – this constitutes insurance fraud.

Example

Dental fee is $100. The insurance pays 80% and therefore covers $80, leaving the patient to pay the remaining $20. If we reduce the total amount owed by $20 by writing the patient portion off, your insurance provider has ended up paying the full $80 fee, or 100%. The insurance provider is now responsible for 80% of the $80 or $64. Writing off the original patient portion of $20 defrauds the insurance company of $16.

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Can you directly bill my insurance company?

Yes, provided we have previously confirmed applicable insurance coverage is in place. Contact your insurance provider for a comprehensive description of covered services and claim processes.

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I have insurance coverage. Why do I have to pay up front?

Some insurance providers have a direct billing option while others require you to pay up front and submit your receipts for reimbursement. Depending on the insurance provider, we can submit your receipts for reimbursement directly from our office or you may have submit them manually yourself.

Regardless of the billing or reimbursement process, your insurance policy may not completely cover some services and/or fees. Contact your insurance provider for complete details on dental procedures covered by your policy and the claim process.

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Can you get my insurance information for me?

No. The privacy laws governing both the dental practice and insurance providers limit our ability to access or request specific details about your policy coverage. Insurance companies do not have a legal obligation to provide us with thorough or accurate information about a patient’s coverage. Any information we receive from insurance companies is provided in general terms as a courtesy only.

Contact your insurance provider for a comprehensive description of covered services, fee schedules, deductibles, and claim processes.

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I am covered by more than one insurance policy (a primary and a secondary). Why do I still have to pay?

Most insurance providers will pay for dental services up to a specific amount, based on a fee schedule. Your primary insurance provider will cover dental services up to its maximum, based on its fee schedule. Your secondary insurance provider will often cover what your primary provider does not, subject to the fee schedule maximum of your secondary provider. If the fee schedule for Londonderry Dental Centre II is different than the schedules used by each provider, you may still owe the balance after both insurance providers have paid.

Example

A crown costs $950. The patient has three insurance policies: A, B, and C. Each policy will cover 50% up to the fee schedule maximum of $875. Policy A and B will each pay 50% of the maximum ($437.50) to total $875. Policy C, however, will not cover anything as policies A and B have already covered everything up to policy C’s maximum. The patient is responsible for the outstanding $75.

Some secondary insurance providers will not offer any coverage if their coverage mirrors that provided by the primary insurance provider.

Example

Both the primary and secondary insurance providers cover 80% based on the same fee schedule. If the primary insurance provider covers the dental service, the secondary provider will not pay the balance because the primary provider has already paid what the secondary provider would have paid if it had been the only insurance provider. In other words, the secondary provider is redundant.

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Can you tell me specifically what will or will not be covered?

No. Insurance providers have no legal obligation to provide us with specific information about a patient’s coverage. Because hundreds of insurance policies exist, we cannot be familiar with all of them. Contact your insurance provider for a comprehensive description of covered services, fee schedules, deductibles, and claim processes. For major procedures such as crown and bridge, our office can submit a predetermination of treatment to your insurance provider to obtain a closer estimate of what your insurance coverage would be. This still provides only an estimate and the exact coverage remains between you and your insurance provider.

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Why do you provide/offer procedures that are not covered?

As dentists, we are responsible for providing you with the best clinical care and treatment options with your health concerns in mind. We do not know with complete certainty which procedures will be covered. If we based our treatment options on the limitations of insurance coverage, we would not be able to provide you with the quality dental care you deserve.

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