Recently my OH managed to get employment with some great Health benefits attached, including an all singing all dancing dental policy which pretty much covers everything at 100%.

This was timed nicely, as I had to have four root canals done and it could have worked out rather expensive if we didn't have the cover. As I wobbled up to the counter after a marathon 3 hour session, I was a little surprised to find out that even though I had 100% coverage, I would be getting charged.

Why? Well as I have had it explained to me, an amount is set every year as a fair payment for treatments, and thus this amount would be payable under all dental schemes. However, Dentists may choose to charge more than this, thus the extra amount.

My Dentist is very good, and runs a practice in Edgmont, Vancouver, but the downside is that he charges 15% extra for root canals and 10% extra for fillings.

So if you are new and are coming over, it might be an idea to find out how much you are going to be charged, and how much of it is recoverable under insurance.

Also, some insurance policies cover up to the published provincial association rates from last year or even the year before, rather than the most recent list.

Also, most benefits policies now either have a deductable on some of the costs, or an employee copay. My policy was recently changed, I now pay 20% but the deductable was dropped, and at least the insurer is working now from the most recent provincial cost list, rather that a year out of date one...


Anyway, coverage is better than none, and you are lucky to get immediate coverage and not have to wait 6 months like some! Cant say I was thrilled that my employer could just unilaterally change the coverage without any consultation though.

Always worth asking about for dentists, some are definitely better value than others.

Can you buy supplemental insurance to cover the extra costs?

Thats what we were talking about wasnt it?

If two people in a family have work benefits coverage its possible that the difference not covered by policy #1 would be covered by policy #2. Not sure if that applies if the fees charges exceed the statute guides, but they should cover any deductable or copayment.

No, I didn't see anything about supplemental coverage in the two posts. I also have supposedly full dental insurance from work but like the OP I sometimes have to pay an extra cost. I also have to pay up front and get reimbursed later. I was just wondering if you could purchase extra insurance to cover the extra costs that the dentist charges?

I had a head bashing moment with optical coverage.

The policy covers 80% of costs up to a maximum of $450 ( I think thats the max amount)

I buy a years worth of contact lenses at considerably more than $450 .

So I was expecting $450 back ( 80% of total cost up to max of $450)

what I got back was 80% of $450. No amount of explaining seemed to convince them they were wrong , my point being that if that is the way they are going to calculate it then you are NEVER going to get $450 worth of coverage

80% of a maximum of $450 is what I would have expected, but then I expect the worst from insurance coverage.

Up until recently my plan covered up to $250 for optical, but didnt cover the actual eye exam! I dont need glasses (yet), so I was on the hook every time I got my eyes checked!

Anything that is not provincial sourced is "suplimental"

I doubt a second plan in addition to what your employer provides would be cost effective. Its probably cheaper to just pay the shortfall rather than pay for a second policy.

Many (most?) insurers now have online facilities for dentists, physios etc to pre register so that your claim is submitted directly and you dont have to pay whatever they cover up front. If your dentist hasnt done that you could encourage them to, or else go somewhere that does.

That's what I feared.

My dentist does this every time. They can do it online and it only takes a few seconds in most cases. They enter the treatment they are proposing and their cost and the insurance company confirms what they will cover and what the patient has to pay for. They make sure the patient agrees to pay for their part before wielding their instruments of torture.

Yup Zoe same as o/h's chiropractic coverage. States that you get coverage up to a set amount (I'm sure this was about $450 too) so we send in all of last years reciepts (again like you waaay more than $450) and lo and behold they basically take $450, take off the deductible, then give you back 80% of the rest.

Still better than a kick in the nads though I suppose.

Is it only me then that has a problem with how this is worded. I think it is false advertising. How can it be up to a maximum of $450 if they will never pay out $450?, surely then its up to a maximum of $360

Its a maximum of $450 because if you are lucky enough to have 100% coverage, then they will pay out $450.

You have a 20% deductible, so they pay out 80%.

Say my car is covered for $15000, they wont pay out $15000 if I total it, I have to cover the deductible... same thing innit?

Its a bit smoke and mirrors I agree, but thats insurance companies I guess, this is no better or worse than most of their wording. All a question of grammar and punctuation I expect...something I probably should refrain from commenting on.

ok then..orthodontics (braces) my kids have 50% coverage up to a max of $2500..so if the treatment is $6000 i will get $2500 back and pay the rest and not 50% of $2500?

When our new benefits were explained to us I got the impression that I could get up to $2000 back total on orthodental, at 50%, for each kid under 19 , but thats my plan....If in doubt ask your insurance provider. They all have 800 numbers...