We submit your claim. You pay your portion and nothing more.
Dental insurance is unnecessarily confusing, and most of the confusion is avoidable. Here is how it works at our office and what to expect.
Direct Billing
Where your insurer allows it, we bill them directly. You pay only your share at the desk — no paying the full amount upfront, no submitting forms yourself, no waiting weeks for reimbursement.
Not every plan permits direct billing. Some insurers pay the patient rather than the provider regardless of who submits. We will tell you which yours is before treatment so there are no surprises about cash flow.
Predeterminations
For anything substantial — crowns, implants, bridges, dentures, orthodontics — we submit a predetermination before treatment starts.
Your insurer reviews the plan and confirms in writing what they will pay. You then know your exact out-of-pocket before committing, rather than discovering it afterwards. It takes a few weeks and it is worth the wait on any significant treatment.
Understanding Your Plan
Four things determine what you actually get back.
Annual maximum. The most your plan pays in a benefit year. Once you hit it, everything is yours until it resets. If you are close to your maximum late in the year, tell us — non-urgent treatment can often be sequenced across the year boundary so you get two years of coverage rather than one.
Coverage percentages. Most plans tier by category: preventive care at a high percentage, basic restorative lower, major work lower still. Cosmetic treatment typically at zero.
Deductible. An amount you pay before coverage begins each year.
Frequency limits. How often a service is covered — cleanings every six or nine months, X-rays at set intervals, dentures once every several years.
Government Programs
We are a participating provider for all three.
- Canadian Dental Care Plan — for residents without private coverage and household income under $90,000
- ODSP — Ontario Disability Support Program recipients
- Healthy Smiles Ontario — eligible children and youth under 18
Note that having access to private insurance disqualifies you from CDCP, even if you never use it.
What Insurance Rarely Covers
Whitening, veneers and purely cosmetic work are almost universally excluded. Implants are often excluded or heavily limited, though many plans cover the crown portion.
Where a treatment has a functional justification alongside a cosmetic one, coverage is sometimes available. We document the clinical rationale when submitting.
No Insurance?
Plenty of our patients have none. See our published fee ranges and affordable care options. It is also worth checking whether you qualify for CDCP — a lot of people assume they do not and are wrong.
Frequently Asked Questions
Do you take my insurance?
We work with most major Canadian insurers. Ask us with your plan details and we will confirm.
Why did my insurer pay less than expected?
Usually an annual maximum reached, a frequency limit hit, a deductible not yet met, or the plan reimbursing at a rate below the standard fee. We can walk you through the statement.
Can I use insurance and CDCP together?
No. Having access to private dental coverage makes you ineligible for CDCP.
Do you charge more than my plan covers?
Where a gap exists between our fee and what your plan reimburses, you will see the amount in writing before treatment starts.
Questions About Your Coverage?
Get in touch with your plan details and we will check it before you book. Or book an appointment.