I think it’s fair to say that 2020 has been an interesting year. In all my years of practicing dentistry, I have never closed my practice for 12 weeks straight and I hope I never have to again.
Being closed shifted our schedule causing some of you to have treatment and cleanings delayed, but we do have an opportunity to get everyone back on track and to utilize your expiring benefits before the end of the year. Let’s run through a few questions that can arise while handling these at times complex processes.
How does one go about taking advantage of their plan and benefits?
Clients must make an appointment with a dental provider who will complete an examination, establish a treatment plan, and discuss the services required with the client.
The dental provider will indicate what is covered by the Non-Insured Health Benefits program. Certain services such as dental implants may need predetermination which is prior approval. If the provider does not know the program, the client should contact the NIHB Dental Predetermination Centre and speak to dental benefit staff to determine what is covered.
Service providers who are enrolled with the program generally send in claims to bill the program directly. This means that you should not have to pay when receiving your dental services, including any deductible or co-payment. You will need to show client identification in order for providers to bill the program directly.
Certain dental services are covered without prior approval (predetermination). For these services, the dental professional can provide the service and send the bill directly to the program.
For dental services that do require prior approval, the dental professional must contact the program before you receive services. This is done to make sure the service is covered under the program’s rules.
Some of these steps may vary depending on your insurance, their coverage, and your specific plan.
It’s best you contact your insurance company and ask a few important questions:
- Is my dental insurance based upon a calendar year? Most plans do run on a calendar plan, so it’s important to understand that only two months may remain for you to use your current benefits.
- How many benefit dollars do I still have remaining on my plan? The amount of benefits you have each year is usually based upon what your employer has purchased on your behalf. It’s important to know if you’ve used all the benefits you deserve.
- Can I receive 2 cleanings per year at any time, or must they be spaced 6 months apart? This is really important! If your insurance plan doesn’t restrict you to only one cleaning every 6 months, you can visit us for a cleaning twice per year, even if it’s only 4 or 5 months since your last cleaning. If you have the benefit to use and you’ll lose it on December 31st, come see us! For other dental services like getting dental implants, you may contact your insurance provider to determine if these are covered by your plan. You might also visit a dental implants surgeon for a consultation.
- Have I met my deductible? If you have diagnosed treatment that you have not completed this year and you’ve already paid your 2020 deductible, waiting until next year will only have you pay that deductible again in 2021, costing you more in the long run.
- Do any of my unused benefits roll to 2021? Although I’ve seen a couple plans that do offer this benefit, the majority of my patients don’t have one. If yours does roll, please let us know and we can help build a treatment schedule that will best benefit you.
Ramy Bahu, DDS
