Periodontal Treatment and Dental Insurance

Many patients ask if dental insurance will cover their necessary dental and periodontal treatment. The answer is: IT DEPENDS!

Most insurance policies have a standard maximum annual allowable expense of $1500 to $2000. In addition, each procedure will be covered anywhere from 50 to 100% of the estimated amount. For example, if you require a couple of gum grafts on two different teeth (say, one in your top jaw, and one in your bottom jaw), then the estimate for the treatment might be $2800 ($1400 per graft). However, if your annual maximum is $1500 and each procedure is covered at 50%, then your total reimbursement per graft will be $700, or a total of $1400 for both. Since the total estimate is for $2800, you will receive $1400 from the insurance company you will have to pay the additional $1400 out of pocket.

It is important to understand that in Ontario (and most Canadian provinces) it is illegal for a dentist to write off the difference between the total estimate fee and the amount to be reimbursed by your insurance company. Also, it is illegal and fraudulent to send a CLAIM to an insurance company for treatment that has not already been completed.

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