It is increasingly coming to our attention that many dental plans are changing the benefits they offer their members. Patients are finding they have to pay for dental treatment, even though they have coverage with one or sometimes two dental plans.

Dental Insurance coverage is a contract between the member and the insurance carrier. In most cases the terms of coverage are negotiated between the employer and the insurance carrier. The employer enters into an agreement with the carrier to offer its employees a benefit, based on certain terms and conditions. The terms of coverage are fixed by this agreement, and the dentist or dental profession has no part in this process. The benefits paid by the plan for dental treatment are paid out according to the terms of the contract between the plan and the member.

Dental Insurance Carriers are controlling the benefits they pay out by:

• Introducing annual financial limitations on treatment.
• Introducing limitations on the frequency of dental procedures.
• Basing the benefits on out of date and out of province fee guides.
• Paying only a certain percentage of the fee guide in use.

Some of the changes that we have become aware of are:

• Recall exams, polishing and fluoride treatments to once every nine (or sometimes twelve) months.
• Limitations on scaling and root planning (tooth cleaning), to once per year.
• Composite (white) fillings are rarely covered on molar teeth, but the equivalent silver amalgam (mercury based) filling fee is paid out instead.

Dental insurance companies must be seen as an aid in meeting dental expenses and not as a provider of dental benefits. We will continue to recommend and provide the best treatment for our patients. We can not allow treatment that is in the patient’s best interest be determined by limitations imposed by a third party. Consequently, a patient that will only accept treatment within these limitations, is denying themselves the opportunity of achieving optimum dental health.

There are hundreds of Dental Plans all offering different benefits. Plans are constantly changing the benefits they offer. Notices of changes to insurance coverage are provided only to the patients and contract holders, and not to the dental professionals. Therefore, we cannot reasonably be expected to have knowledge of your insurance limitations. Please understand that if this is of concern to you, it is your responsibility to inform us of any changes to your coverage.

The Canadian Dental Association continues to recommend a complete check up every six months, with annual x-rays. Regular cleanings must be undertaken to maintain optimum gum health, ideally on a six month basis.

In this office you are our number one concern. Your dental health is extremely important, and we are not prepared to compromise our standard of care based on limitations imposed by your insurance carrier. We will continue to recommend the best possible treatment for you, irrespective of your insurance coverage. We trust you will have the same expectations.

Dr. Rodney Shainbom and staff.