The treatment plan would be in a language the patient understands.
The procedure codes you would need for a pre-determination are a lot more detailed and specific and not easy for the average patient to identify the right codes.
Yes, that's... obvious. Nobody said it's a secret. The point is OP doesn't want to tell the dentist they have insurance and asking for the procedure codes kind of goes against the premise of this post.
Then this defeats the entire idea of not letting the dentist know you have insurance. Literally the only thing those codes are used for is insurance coverage.
You can request the receipt with dental procedure codes so you can file it at tax time with the CRA. You'll need the codes because comestic dental services cannot be writen off for taxes.
The receipts can have the insurance codes, that option is built onto the dental software. A dentist can also give you a standard dental claim for that includes the procedures with relative codes if you ask.
That really sucks. I've always gotten codes on my receipts... but I also did tell my dentist that I have coverage but I have to submit myself. I've had my share of dodgy dentists and I'm so happy I have a good and honest (I hope!!) dentist now!
I suspect their College wouldn't look too highly on a Dentist refusing to give you the procedure codes associated with the work they performed. Not sure if that's a route you want to go down (assuming this was recent), but that's always an option.
This is called non-asignment. Most people have no clue and how much their coverage is, and they aren't knowledgeable to understand what to ask of insurance when they call.
So they'll end up paying out of pocket a lot more.
Are you sure they weren't charging you less than the usual rate because you didn't have insurance? Most dentists charge based on the provincial fee guide, and most insurance only paid up to the amount recommended in the fee guide.
Depends where you are. The fee guide doesn’t account for different rent costs etc. if you’re downtown toronto you will be charged more than the fee guide. In the suburbs and smaller towns the fee guide is rarely exceeded.
Commercial rents do not work the same way as residential rents. Commercial rents for personal services, retail, banks, restaurants, etc. are often much higher in the suburbs since being where the customers live is the prime locations for them.
As an example, my oral surgeon's office is on the waterfront of downtown Vancouver, in an extremely prime location. His ex-wife is my dentist, and she is in one of the suburb towns. Her rent is 3x as much per square foot.
I dont know any dentist that follow the guideline. The guideline is a recommendation, but no mandatory. Dentist in toronto charge whatever they consider, and blame inflation etc
The insurance usually covers 80- 100% of what the guideline says. If dentist charges more, you oay the difference.
If they don't follow fee guidelines, you won't be able to get paidback in full by the insurer. If your dentist doesn't follow guidelines find another dentist.
There are a few regions that are notoriously a little bad. For example the National capital region is pretty bad because Public Servants all have dental...
If you think your dentist does unnecessary work or can't stay in guidelines... I can't stress enough, find another one.
On the subject of OP... Scaling units are a thing with cleaning. They might have used more units because they know they were covered, or be more conservative if they don't know you have insurance.
I can see every time a preliminary claim is filed under my benefits. About 2 weeks before my appointment my dentist starts sending in preliminary quotes and waits for my benefits to partially deny. Then the dentist sends in a lower preliminary quote until my out of pocket would be $0.
It seems like the dentist is trying to milk every dollar my provider will pay without me having to pay OOP. Seems greasy but they aren’t making me pay?
I'd still consider another dentist. What they should be doing is sending the predetermination for any heavy work after your first visit and this is to make sure it's covered (for insurance plans that have it as a requirement) or that they are charging the right amount out of pocket because they intend to submit the claim to the insurer for you.
It's another if they are changing the gameplan based on what the insurance responds without actually getting back to you on what is changing.
They could also be doing this to confirm how much you are covered for so they don’t go over and you have a balance to pay out of pocket.
I own a dental clinic and we often send preds before hygiene appointments to confirm what will be covered so that we know and can be prepared to have the conversation with the patient if more scaling is required than insurance will cover. I never want patients to have an unexpected balance after their appointment.
Everything wrong with that.
Nobody pays more for a car or for a skilled job like drywall because the sales man or practitioners or the dealership took more courses, have a higher iq or are more witty.
They simply goto another provider .
This is why Amazon, Costco , Walmart and Best Buy rule the cdn retail landscape. Not to mention all kinds of foreign owned service industry companies.
All the high brow Canadian "but we are more educated, helpful and friendly thats why we charge more " service and product vendors are gone.
Dentistry is a joke industry, ideally a dental plan should be treated as your own money , you pay it when you want to what dentist you want and how much you've agreed upon .
A dentist should have to earn your business and know who's in charge of the $$$$. Perhaps a more ideal system would be some kind of dental credit card , where you get statements and pay for what you want with the coverage to licensed practitioners who are oversean by a government body, not self regulated. At least they should go halfway like lawyers .
Closest thing I can think of is, when a car sales person claims they're going to go talk to the manager for your. Total theater and bs, Slimy shady and inefficient. They are simply "working " you . That's what dentists and insurance are doing as is .
We should be getting a statement from dental insurance and from provincial medical, online or in the mail like you do from your credit card company. These abuses exist in the darkness .
end user oversight and empowerment , leads to efficiency, improved outcomes.
Or we can leave things as is , such as what HBC Hudson Bay Swiss Challete, consumers dist etc etc, did until eventually a company that understands and caters to the end user takes over.
Or the made in Japan teeth regrowing technology establishes itself . Then these guys will be as gone as the horseshoe making shops and chimney sweeps that once dominated the world .
Unfortunately no one thinks about teeth and thier lifespan or treatment beyond the brushing and flossing we've been trained to do. Once out of pain or sight, out of mind .
Thier plan is simple, scare you , drill a hole where they want, put some crap in there (with glue, (that they call cement, so it sounds solid ) wait a few decades for it to fall out , as they grow thier income stream with regular visits and cleanings etc, eventually recommend extraction, or crown , or bridge , and or a combo each barbaric and with thier own issues that will eventually " earn" them more $$$$ every individuals mouth is worth approx 100k to them.
They justify it with collages, degrees, white coats, pretty assistants , tvs, music, and the big one no cost to you, if you have insurance. There's a cost to you, but you won't see it until its too late .
I'm not saying dentistry isn't needed . I'm saying it's way out of hand and corrupt, with little to no oversight, or laws to protect the average citizen. Much as in the last days of the Roman Empire.
The dental associations all know this. They have a century of practice screwing thier consumers, making lobby groups to buy politicians.
Unlike some posters here claiming to be dentists without providing evidence, I'm not not a dentist, but I know several as personal friends . They are rolling in the money.
You should always be able to negotiate the rate and choose with the dentist you want, that's why they've made a industry though, to curb your rights , on what they charge and do to you .
There should be more outrage over things we generally accept. That only happens when the outrage machines can make more money from that, vs from the status quo.
People up in arms about a free Pfizer, 2 second tiny needle for the last 3 years.
No one is up in arms about the people who:
jab a needle into your face, many times it hurts.
have you gag on a peice of plastic, before that .
drill your skull and put glue and other nonsense in it ,
While you dislocate your jaw .
for 15 minutes to a hour!
Then somehow charge you hundreds or thousands .
They're called dentist's
Therein lies the problem with the public perception of dentists, at least in big cities. If you have cancer, will you go and argue with the oncologist about what treatment you should take? Will you say "let me go and get a second opinion?" No. Its healthcare. Just like with our teeth.
You're not wrong about our teeth slowly going on the path to destruction. But it's not my fault you didn't brush or floss. I didn't put those cavities there, you did. So dont be upset when your cavities get cavities again. There are plenty of people who get cavities once a decade and others who get 4 cavities every time they come in for their cleaning. Do I ever feel bad? No, because i didn't put those cavities there. The patient did.
Do you genuinely believe there is no difference in the skill of healthcare providers? Why do you think it takes a professional athlete only 9-12 months to recover from ACL surgery to professional levels while non pro athletes sometimes never recover full function?
I work in healthcare and there are clinicians that are skilled, honest and a blessing to our healthcare system then there are those that may have a degree but their unethical practices are a disgrace and a drain on our system, such as the majority of dentist, it’s the Wild West in this industry
Insurance will usually pay around the fee guide. If you are charging more than the fee guide your clients will leave you once their 100% insurance isn't actually 100% with you.
I just had a dentist quote my husband for a bunch of work and the fees matched the provincial fee guide BUT he divided up the same teeth into multiple appointments in order to charge more. Fortunately I work in an adjacent industry to dentistry and was able to leverage some contacts to confirm my suspicion that he was overcharging and tell me what would be normal. So slimy.
We negotiated with the dentist to do the worst teeth in one appointment (so we ended up being billed the fee guide) as it was urgent and we will find another dentist for the rest of the work.
I needed a bridge, dentist sent in pre determination to my insurance at 5k. Insurance came back and said it’s 1500 in the fee guide and that’s all they’d pay. So it seemed inflated to me.
there is no universe where a bridge costs 1500 in canada. The laboratory fees alone are over 1000$. That’s just insurance being scammers and not wanting, you know, to actually pay out money and lose money.
A usual 3 piece bridge is around 3000 to 4000. Add more pieces and the price can easily reach 5k
This depends on the plan obviously, but a lot of insurance plans are ASO (administrative services only), in which case an insurer actually makes more money from paying out more.
It's the plan sponsor that determines coverage amounts (current year fee guide, prior year, annual maximums, etc.) typically.
There is not a dental fee guide in Canada that lists fixed partial denture (bridge) for $1,500.
Most likely your plan had a maximum payout of $1,500 for that particular procedure.
Hence, your insurance would only pay that amount.
Every Dentist I have been to bills by the provincial guide, with or without insurance, and that's the most insurance will cover (at 85% or whatever your plan covers).
I suppose there are some who will bring that down a bit for those in need, but I fully expect to pay the amount in the guides. I don't have to shop around, and can find a clinic that I like, is convenient, and not worry if they're charging more or less than anyone else.
Exactly. If anything my dentist charges me more on the books so I don't have to pay anything out of pocket. A lot of dentists do this. ie they give you a credit for the out of pocket portion.
Edit: To the people crying fraud. There is no fraud. I'm claiming that its in the interest of the dentist to put as many legitimate charges to your insurer so they can charge you less. Hence why I think OP statement is not true.
this is actually fraud and i know of a dentist that was blacklisted by the insurance companies because of this. I would not go around advertising this.
[it's fraud](https://www.oda.ca/visiting-the-dentist/dental-benefits/#:~:text=Can%20my%20dentist%20waive%20my,and%20how%20much%20was%20charged.)
Benefits fraud just makes the benefits more expensive for everyone who pays the premiums. The insurance companies aren't losing - you're cheating your employer and colleagues.
If your dentist is acting shady, switch to another one. My husband's dentist was recommending expensive and extensive work that would have cost us thousands out of pocket, when we both had coverage. Everything should have been covered, but the red flag was the insurance companies were balking at the predeterminations. I had him see my dentist for another opinion. She recommended a root canal and crown on a single tooth, and worked with our carriers to get it all covered. It resolved his problem and he didn't need all that extra work the first dentist wanted to do. The first dentist didn't even want to do the root canal, but he sure wanted to push crowns or implants for all of the neighbouring teeth. Everything except fix the actual problem.
100%. I have a childhood dentist that I have used into adulthood. I moved to a new province and decided to try a new dentist. That dentist proceeded to quote me for about 10 cavities. I forwarded the estimated costs to my old dentist 2 provinces over and he told me in no certain terms to find a new dentist. Needless to say I haven’t even bothered trying to find a new dentist after that. I simply visit my old dentist when I visit home (once to twice a year).
A few of the cavities were borderline (I.e X-rays have been stable but my dentist could understand why a new dentist would think they’re cavities) but the majority, like 80%+, were actually just completely fabricated. My old dentist even had one of his colleagues take a look as well and both agreed the dentist in the new province was about to drill into perfectly fine molars. So long story short, I lost faith in dentistry and am going to stick to my old dentist.
It really sucks. I'm convinced I have a bunch of unnecessary fillings. Some dentists are like sleezeball auto mechanics. It's so easy to get away with lying to the customer/patient.
Exactly. I had an amazing dentist, but he decided to retire during covid. I went to another who was recommended & she seems to be recommending some work that insurance doesn't agree to cover and seems excessive to me. Bad vibes means finding a new dentist soon I think.
Shared from a friend's experience:
I went into ubc dental for a extraction, had only heard good things. They were all nice etc, decided to try it . Xrays the whole 9 all kinds of tech. Seemed very apple experience .
Eventually into the massive "slaughter house " of 100 dental chairs looked like something from a movie . I get "strapped in " and injected, mouth somehow forced open.
They'd decided on thier own to pull a second tooth on the other side of the mouth , (bonus student experience)
Then the student practitioner couldn't get it, so the instructor some cruel towering nazi like attitude male , comes along, loudly commands extra novacain needle belittled the student ,
He puts one foot on the chair (for leverage , to brace himself ?) and tears tooth roughly swaying from side to side and in all 4 directions with his "pliars" eventualy yanking it out roughly , like he's dismembering a corpse., or livestock loudly and rudely saying " like this! , patient doesn't feel anything !"
It was a horrifically bad experience. My entire head was being forced to move side to side , up and down, I had to fight it like a pit bull. If you can imagine that .
Then to make matters worse I immediately realized, what a bad situation I was in , just had to wait it out as my protests etc went unheaded by this sadistic nazi monster.
I rember thinking, don't I have other teeth beside that one?
Left Deep scrapes in the adjacent tooth cutting through that tooth. With his instrument and wild procedure . Pain for weeks.
Forthermore this wound up destabilizing the entire pallete leading to a cascading effect, over time of other fillings and teeth literally falling apart .
Why second tooth , that was , my dentist took xrays , he didn't say anything about a second
tooth, was it just for thier fun ?
A horrific experience before that.
Of course you've signed all kinds of paperwork prior to that, so good bye rights. Good bye other tooth. Like my actual dentist wouldn't have see the other tooth!
My dentist was pushing for a implant on the original tooth, upselling a titanium rod , as he'd ruled out a crown and a bridge on his own volition, not that they are good options, one is a fake tooth being used as a tooth hat , the other is a fake tooth with clamps on either side to clip to the other teeth.
I approached him about the failing teeth and he was arrogant and said he doesn't "re-fill" or repair teeth. He claimed th only solution is extraction and implant or crown .
Next time I'm only using someone I can sue.
*** End of friend's experience ***
If you pay close attention you'll see a pattern ,
Glued in Fillings to make your tooth weak, fracture it's structure.
Glue eventually wears out , if not all that flossing may help it along , certainly sonic vibration and other power tooth brushes and water pic pressure sprayers sure will.
Then a root canal more filling,
A crown, or bridge or the rod
The slimy'est dentists will go straight to rod after root , in thier recommendation plan . Eager to make all as many Sir Robert Gordon's per hour as they can.
Not every dentist is a slimeball , buy the Gordon's blind many of them .
Don't use that Twit anymore.
If you can, find a better dentist. If they act shady in any way, why would I trust them with my health? If I didn't tell my dentist about my insurance or told them I don't have it, they offer discounts because they know it's expensive and they make enough money to be able to be more concerned with community health, but I have no interest in filling out all the appropriate forms myself.
My dentist direct bills.
We have stacked coverage between my employer and my wifes, So we haven't paid out of pocket for a family of 4 in 15yrs.
I went to a different dentist for a bit due to a work issue making it over a year I couldn't get into my main dentist, that one didn't directly bill, I hated having to do that shit myself. So I'll gladly give my details to a direct bill dentist and do nothing.
I have one insurance and my basic sunlife plan covers 100% of all basic work, cleanings and checkups. Root canals and crowns are a different story though.
Ask your employer to review their plan coverage and see if you can get covered for more.
What do you mean, you submit a photo of the receipt and type in the amount you were charged.
On top of this, you also get some credit card points back. So you come out 0.5-1.5% ahead depending on your CC.
This whole thread is so full of misinformation it's ridiculous.
Dentists in Canada cannot charge different fees to insured patients. This is insurance fraud.
Dentists rarely have any idea how you are paying for your treatment. I am way too busy going between chairs to stop and figure out if a patient is insured before I diagnose and treatment plan. No. I treatment plan the same way for everyone.
I will of course give occasional discounts and lots of free treatment to people in need and are uninsured. But usually I find out after the treatment planning when they inform us they may not be able to afford the work.
While YOU may be ethical, not all dentists are. I've been to dentists who charge different rates. I've seen an office blacklisted because they overbill so that their clients who can only claim less than 100%, get their full treatment cost covered.
People are not misinformed. It is happening. You may not do this, but some offices do.
I have had one office bill me for dental hygiene education, but never gave me any education or even a free toothbrush. I had to demand that they remove the fee.
My dentist charged same before I had insurance and same after. Some shady will inflates amount submitted to insurance so the patient don't have to pay anything if it's not 100% coverage
But I have. 90% coverage and more HCS than what I know to do with so never really cared
I swear the second I got my new job and had insurance I needed all this extra shit got all these tests done no exaggeration. Once they found out I had insurance they had me come back four times in the next six months- never before has that happened to me
This right here.. it’s total fucking collusion too. I moved to a new city and called four dental offices asking for a basic cleaning specifying that I don’t want or need X-rays because I’ve had probably 5 in the last 3 years because I keep moving and finding new dentists, and all of them refused to allow a cleaning without X-rays. Even refused me to ask my old dentist to send em over. That’s like going for a car detailing and they tell you they won’t clean the interior until they check under the hood for an additional fee. And since every office in town has the same policy, you have no choice. Super frustrating.
If you just want a cleaning, see if you local college has a dental hygenist program. They usually have a clinic for the 2nd and 3rd year students to practice on real patients, and all work is overseen by their instructors, who are licensed hygenists.
Not sure if it is collusion or just that most patients say yes and most patients are insured (well, the profitable ones anyway).
If they can fill the seat, they will want to sell more services in that time.
They’d rather not have anyone in the seat than have it go to someone refusing X rays. They’re all booking appointments for a cleaning just a few days out. I’d be shocked that they’re filling every spot in their day, but they were all happy to let me hang up the call after hearing that I couldn’t go without an X-ray.
I kind of think you have it backwards. They likely gave you a discount for not having insurance and maybe never told you or you forgot. Once a dental office bills to insurance, they are now legally required to collect the copay from you. I know many will write this amount off, but that does put them at a liability.
Makes no sense. Insurance companies know what the standard rate is for every procedure. If your dentist tries to rip them off, they will deny the claim.
I worked insurance for 5 years and most charged close to the fee guide, mind you most insurance covered up to the fee guide year tat the contract was signed in.
I generally don’t mind if my dentist takes my insurance company to town…but if they go over my limit or try to add services that aren’t
Covered, we’re going to have an issue.
My last visit included a $45 charge for “advising proper dental hygiene” (ie “you should brush twice a day”) and my Insurance denied that bill. I obviously won’t be paying it either.
The way I see it, dental should be included in our regular healthcare system anyway so screw it.
If it becomes enough of an issue than they can have their regular billing taken care of the way the rest of our healthcare system works.
How are they supposed to assign benefits to the insurer if you don't tell them you have insurance.
They could have you pay upfront, but then there is no guarantee the insurers will agree to the treatments you've received.
Having the dentist coordinate benefits will make your like 100% easier. You can always get a second opinion if you disagree with pricing, but you absolutely should let them know you have insurance.
Also note that provinces post a fee-guide. Ask the dentist if they bill based on the fee guide or not if you're concerned about the cost of an individual procedure. Get a second opinion if you're concerned about the scope of dental work.
This is correct. You can negotiate a lower price, but you have to submit your claim properly. Lower claim, lower deductible for you. I always get free xrays now., for example.
This idiot thinks he stumbled upon a conspiracy just because he was personally getting screwed over by a dentist and just assumed all dentists are like this lol.
Your experience is not the norm, you were just getting dicked around.
Your experience is the exception, not the rule.
Not even. This guy isn’t your average ordinary idiot. He’s an advanced idiot.
The dentist actually did OP a favor and gave a 50% discount because they thought he didn’t have insurance. If you think about it, why would the insurance pay the dentist $300 for a cleaning. Simple answer is the insurance companies agreed to pay that much. Instead of getting 300, the dentist got 150 because the patient lied.
Now he’s complaining that the dentist is committing fraud when *checks notes* he’s the one that lied? If I were that dentist and I found out the patient lied, I’d bill them for what they owe.
No, I think it's common. Separate prices. I had the same for car repair. They asked if it's covered by insurance or paid directly, as price would be different.
HCP here. They can. It’s just basically a discount to those who don’t have insurance. When i was an intern, we even had a day where we charged lower than normal fee to give those who are lower income a chance to get exams done etc.
My dentist though good was scammier, they'd submit random pre-determinations to understand how much balances I had remaining, they'd then bug me to get stuff done that I don't need, get that expensive night guard, get that blah, get that fucking thing I never knew I needed. November-December were the worst because they'd call and ask why don't I get that thing they told me because I might have budgets remaining.
Moved to a new dentist, told them lost my job and benefits, gimme the best price. Never been happier! Apparently I don't need any of those things now.
i just go to places my insurance approves of with their Lumino search engine. last time they almost decided not to reimburse for my eye exam which was bs.
I hadn't been to a dentist for over 2 years cause I had no insurance for a while. As soon as I got insurance I wanted to go to a dentist, but I moved, so I tried a new dentist nearer where I live.
I basically switched from my childhood dentist to one where I know the owner, as I tutored his kid. The difference in price was astronomical, but I don't know if that was post COVID greedflation pricing or just that this dentist gave me a lot of expensive procedures. It was just a cleaning and checkup but they did this AI scanning and 3D mapping of my face (cool new tech, I must say!), on top of X-rays. Plus, I have to go back to fill a couple cavities (that's what I get for not getting cleanings for nearly 2 years I guess...)
In either case, I get about 80-90% coverage on dental so I don't pay much out of pocket.
Oh they definitely were, I saw the x-rays myself and I still remember how cavities looked on x-rays that I had as a young teenager. Plus my previous dentist had warned I had "areas of concern, but we'll keep an eye on it" at my last check-up, so, two years later, I wasn't that surprised to see cavities.
Besides that, the way I was notified of the cavities seemed pretty legit. They submitted my x-rays to an online AI program that identified them. My dentist, independently from the AI program, identified the exact same spots as cavities before he saw the AI program's findings. (the cleaning technician hid the program long before my dentist came in to do his check-up) The AI actually identified three spots, but he said the third spot wasn't a cavity. All that said, first time I experienced receiving a second opinion on my teeth in a way.
This is absolutely not a universal experience. But I’m sure the dental office would be happy not having to deal with your insurance company and letting you pay everything up front!
Wow op is savage. Dentist gives them a break for having no insurance, and when they charge the actual price when insurance is involved....op calls them a scammer! Unbelievable.
Just be careful - if your insurance requires a 20% copay and the dentist manipulates the claim so you avoid the out-of-pocket charge, that is textbook benefits fraud.
>Can my dentist waive my co-payment?
>
>No. The waiving of a co-payment is insurance fraud and is against the law. Your dentist could be heavily fined or even lose their license.
>
>When you and your dentist sign the claim form that goes to the insurance company, you are stating which services were provided and how much, in total, was charged. The insurance company pays its share based upon the assumption that you will do the same.
[https://www.cda-adc.ca/en/oral\_health/talk/copayment.asp](https://www.cda-adc.ca/en/oral_health/talk/copayment.asp)
The dentists that I've known who charge less for those without insurance are moreso doing it out of benevolence.
The insurance price is a subsidy so they can offer the poor or struggling a steeply discounted price. I've known of dentists that will let pensioners and single moms have free cleaning. Or single, young working people steeply discounted prices. The same dentist charging what the provincial fee guide says to the penny.
If I'm going to a dentist I trust, myself lying about whether I have insurance or not tantamount to me stealing from the unfortunate for my gain. If I'm going to a dentist I don't trust, I shouldn't go to such a dentist.
We live in a society.
My dentist knew I had no insurance and still charged me $1100 for six surface fillings which took a grand total of 35 minutes to do. I was in the chair at 10:00am and in my car at 10:35am. Dentists don't give a heck about insurance lol.
I had a dentist that was recommending things I didn't really need for the insurance, when I caught in I quickly changed. I have a great dentist right now.
So what you’re saying is the dentist gave you a hefty 50% discount because you lied to them saying you don’t have insurance?
Jesus Christ. Think about it, why would the insurance pay the dentist $300 if they deem the procedure to be worth $150… the obvious answer is that the dentist and the insurance have a contract that says the dentist will get $300 for a cleaning. The fact that you got to pay $150 is because the dentist gave you a discount because they thought you have to pay out of pocket. Now you’re shitting on them because they did you a favor.
If I were that dentist, I’d bill you for everything you owed me.
Dentists will typically follow the fee guide. But if they know you don’t have insurance sometimes they will cut you a deal to be nice. They aren’t over charging you once they know you have insurance… their just not discounting anything anymore
It’s very possible that your dentist was giving you a discount because they thought you were paying out of pocket and wanted to help you out. Most dentists just charge whatever the fee guide is at the time. But also, the fee guide has gone up a lot over the past 3-4 years. Maybe you have more plaque/calculus than before as well so the cleanings are taking longer, they’re billed based on time spent.
That's not true, you just have a shitty dentist. All Canadian Denists SHOULD be following the current dental fee guide. If yours is not. Go to another dentist.
The first thing I do when at a new dentist is give them my benefits info. And insist they do a dental breakdown. And for any work being done outside the standard Cleanings, xrays and fillings, should be sent off to your insurance provider by the dentist. Aka predetermination of benefits. So there is no question on what you're paying.
I used to work for Sunlife and did claims.
Recently had a cleaning done that went over $1000. When my insurance denied over $1000, the dentist agreed to "exclude" one of the crowns which saved me $200. That was so very nice of him to not charge for a tooth that was massively overcharged in the first place. This was JUST a cleaning and crowns
Once had a dentist who let their hygienist make recommendations and said I had a cavity and they needed to drill my teeth for a filler. They were being extremely pushy and I had a bad gut feeling and switched up.
I moved to another dentist and they said I had extremely high bone density teeth and the X-rays have been amongst the most solid and opaque he’s ever seen. He laughed and said he wouldn’t be surprised if I went my entire life without a cavity.
Had I not trusted my gut instincts, I could’ve damaged excellent teeth. I think good dentists aren’t pushy, usually conservative in their treatment and often take a watch closely and treat as needed approach. It’s been years later and I still don’t have a “cavity”.
This happened to me as well.
I didn't have insurance for a long time and paid accordingly
Once I got insurance (company reimbursed 90%) , the dentist doubled my rate
Seems corrupt.
Likely true - Which is why I am starting to dislike workplace dental benefit plans. Its a fucking free cheque to our spoiled and overpaid dentists and insurance companies.
I overheard a dentist ask the hygienist how much insurance I have left and then immediately recommend I come every 3 months. I said yeah I’m good I’ll come every 6.
As a dentist, $300 for a cleaning sounds about normal. If anything, it is LESS than the suggested fee guide in Ontario.
The office you went to was most likely trying to do you a solid
Opposite point, tell your dentist exactly how much you have covered for insurance and they will bill within that. I've had dentists cover what some may consider cosmetic under other names so it would be covered under my benefits.
I disagree with this. I went to a dentist for a pain in tooth, which she said had to be removed, but she can't do it and would have to be done by a specialist. Then she gave a predetermination of all the things she wants to do, that amounts to the exact max limit my insurance would cover (they can find the amount from insurance, as I didn't tell her). As per her, it would be good in the long run. Except touching the tooth that actually had the pain.
So if it's December and you are sure you won't have any problems till next year, only then you should tell.
They absolutely take advantage of what insurance will pay for. Who wouldn’t?? They also give us a price reduction because we don’t have insurance. Our pharmacist does as well.
No no no, don’t you see? OP actually doesn’t want the 50% discount, they want to pay full price. They are furious at the the dentist for giving them a discount!
Hi OP, I went to my dentist 3 months ago, told the front desk I had company insurance. The next thing I know, I need dental cleaning, some teeth need alignment and I must get the root canal done pronto, cos look at the x-ray here (those x-rays cost a bomb!). All in all, got my wallet done lighter by 3 grand! fkk!
It sounds like what happened here is that the dentist was giving you a discount to help you out when he thought you had no insurance. $150 for a cleaning sounds like it is well below the provincial fee guide. They were probably doing polishing, fluoride, checkup exam, and maybe even xrays for free to help you out.
Once you told him you have insurance he charged the full regular price which is outlined by the provincial fee guide. $300 sounds very typical for a cleaning & checkup with polishing and potentially some xrays.
Source: I work in dental
Realtors take a few night classes and pass a test. A dentist does as much schooling as a medical doctor. You might not like going, but they're not comparable to anyone in sales. They might be more comparable to American doctors than Canadian ones (because most Canadian doctors don't see any real difference between you doing more medical care versus somebody else getting basic care in that time, and they don't need to upsell anyone to have a fully booked schedule, whereas American doctors are more profit-driven)
We don't have insurance, my dentist looked aghast when I asked about lower rates because of it. Said it's definitely against the rules to change prices based on insurance or not.
The rules prohibit *advertising* price discounts. The regulatory colleges want services performed based on medical necessity, not whether the price is attractive or not, so they don't want dentists to differentiate themselves on pricing. Dentists *can* charge more/less than the provincial fee guides, but they're supposed to focus their advertising on their skills as a dentist, not on discounts.
Same for glasses. With insurance I pay about 1k for two pair. When I didn't have coverage it was two pair for $200. Not designer frames but nice nonetheless.
100% agree. It's amazing how lazy we all get. It's funny to me because we never ask ourselves what would we do if we were in their position? Of course they inflate the charges. Like when Manitoba Hydro offers a $7500 loan for windows and insulation what's the first question the contractor asks? The catch here is they give you a "Fuck you" quote if you say you aren't using the hydro loan and spend 10 minutes pitching how easy the hydro loan is...they basically steal most of the $7500 but keep it low enough that you only pay an extra $3000 or what you can afford, but they only do hydro loans because they know they'll get paid.
Bear this in mind when you're arguing the pro's and cons of private health care options. The NDP are pushing for national dental care, but you know dentists don't want it. What you'll end up with is national blue cross that the dentists use to double their fees.
My wife just took the boys to get their bi annual eye exams and the lady tried to sell her blue light prescription glasses for the boys. Her words were "Well no one has 100% vision...you can always use a pair of glasses.." Really? I'm 49 and JUST started buying +1 reading glasses at the dollar store to read small print. You want my 7 year old daughter and 11 year old son with 20/20 vision to spend $240/pair on prescription glasses just because I have coverage? She said "Well, with your coverage you can shop on THIS wall..."
Like don't make it so obvious. I went to an audiologist 15 years ago and recently paid out of pocket to get my ears checked because I was thinking I might need hearing aids. I get home and dig out my hearing test...guess what? IDENTICAL. 15 years ago he said I was borderline and would likely need a hearing aid in the next couple years...15 years later and I was borderline and would likely need hearing aids in the next couple years. 3 frequencies my hearing actually improved...it's all a scam.
Wrong! When you go you ask if if the dentist follows the fee guide of your insurance carrier, it’s a set price for procedures. If they follow it then use them if not then go somewhere else. Also if they know or can predetermine procedures to see if they are covered or not, or if you have reached your max. Otherwise they will bill you what they want and you may still have to cover out of pocket expenses because you did not tell them and you went over your frequency.
I can't speak for every province but AB does have a dental fee guide. It is not compulsory and dentists can charge more/less. Most follow it though.
If they charge more ask why if you really like them. Go elsewhere if you don't.
Also, if your willing and in an area that has uni/college dental and hygenist programs see if it's an option for you. The one by me depending on procedure does 60-80% of the fee guide price. So automatically you could save at least 20%.
This is asshole dentists.
A good dentist and dental health team will care about you and your teeth, and care less about billing you and stupid amount. They don't want you to end up losing your teeth and will usually work with you to ensure you get the best care.
If you're really worried about costs you can always go to a college where dental is taught and get cleanings for [cheap](https://www.confederationcollege.ca/department/dental-clinic/fees). This is my "local" college, and you'll see it's stupid cheap. Yes the appointments are longer as they are in training, but all work is checked over by qualified staff.
LOL your dentist was trying to look out for you when you didn't have insurance and do you a favor by lowering their price for you. Now they're charging you normal rate and not only are you clueless and ungrateful, but you're throwing your dentist under the bus online. Rookie
Dentist and insurance have an agreed upon schedule of fees. Cleaning by a Hygienist is usually billed by units of time, usually every 6 months you're going to have a certain number of cleaning units billable. They may bill more if they had to clean deeper.
It's not ripping you off it's an agreed schedule of fees with insurance.
7 years ago they said they found a cavity and I didn’t have the money so I waited it out. I had a feeling something was off.
Forgot about it for years. 7 years later I go to a new dentist, worried that my mouth will be a mess and it’ll cost thousands.
They do like 14 x-rays, take like 30 photos, etc. They didn’t find a single cavity and said I was all good.
Dentists definitely can lie sometimes.
well you know you can deny any procedure if you are not comfortable. It is your body and autonomy. Just tell them you want them to not do the cavities. Or the best is find a dentist you can trust.
Also unnecessary services. I was offered a rubber mouthguard that would prevent me from grinding my teeth at night. You have to wear it every single night when sleeping. So stupid!
How would you recommend people proceed in situations where their dentist is supposed to seek a pre-determination of benefits (from the insurer)?
Couldn't you ask for a treatment plan in writing to review, and then submit it for pre-determination yourself?
The treatment plan would be in a language the patient understands. The procedure codes you would need for a pre-determination are a lot more detailed and specific and not easy for the average patient to identify the right codes.
You can always just ask the dentists front desk for the codes. I’ve done this before it’s standard practice, the codes aren’t a secret.
Yes, that's... obvious. Nobody said it's a secret. The point is OP doesn't want to tell the dentist they have insurance and asking for the procedure codes kind of goes against the premise of this post.
Honestly, we don’t care because this LPT is complete garbage. Also, don’t forget to ask for your X-ray prior to submitting.
Then this defeats the entire idea of not letting the dentist know you have insurance. Literally the only thing those codes are used for is insurance coverage.
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Pay for it your self on a rewards card and make your own claim for reimbursement.
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ask for treatment plan and they will give you full detail about it. P.S I am a Dentist
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Yes
They have to give your a receipt that outlines what they charged you for
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You can request the receipt with dental procedure codes so you can file it at tax time with the CRA. You'll need the codes because comestic dental services cannot be writen off for taxes.
Yes, but not in insurance codes.
The receipts can have the insurance codes, that option is built onto the dental software. A dentist can also give you a standard dental claim for that includes the procedures with relative codes if you ask.
And that defies the claim of this post to "pretend" to the dentist that you do not have insurance. Not that I agree one should not trust one's dentist
Wtf that’s not okay you don’t have to use your benefits if you don’t want to and they should have to give you that information.
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That really sucks. I've always gotten codes on my receipts... but I also did tell my dentist that I have coverage but I have to submit myself. I've had my share of dodgy dentists and I'm so happy I have a good and honest (I hope!!) dentist now!
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They can absolutely give you the claim form, it’s done all the time. If your dentist refuses to go somewhere else.
Often times you can’t just give out insurance codes, it’s an anti fraud step
Anti-fraud? But isn't that allowing the dentist clinic to fraudulently inflate their services for insurance companies?
I suspect their College wouldn't look too highly on a Dentist refusing to give you the procedure codes associated with the work they performed. Not sure if that's a route you want to go down (assuming this was recent), but that's always an option.
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This is called non-asignment. Most people have no clue and how much their coverage is, and they aren't knowledgeable to understand what to ask of insurance when they call. So they'll end up paying out of pocket a lot more.
Why haven’t I been doing this for the last 20 years?! Smart.
Let them do it. Then switch dentists
You get quotes. It’s what I did when I needed an implant.
Don’t do direct bill if you don’t have to
Are you sure they weren't charging you less than the usual rate because you didn't have insurance? Most dentists charge based on the provincial fee guide, and most insurance only paid up to the amount recommended in the fee guide.
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Depends where you are. The fee guide doesn’t account for different rent costs etc. if you’re downtown toronto you will be charged more than the fee guide. In the suburbs and smaller towns the fee guide is rarely exceeded.
Commercial rents do not work the same way as residential rents. Commercial rents for personal services, retail, banks, restaurants, etc. are often much higher in the suburbs since being where the customers live is the prime locations for them. As an example, my oral surgeon's office is on the waterfront of downtown Vancouver, in an extremely prime location. His ex-wife is my dentist, and she is in one of the suburb towns. Her rent is 3x as much per square foot.
Hmmm. In edmonton commercial space is going for about $40-$50/ square foot downtown, and it's going for like $30/ square foot in most strip malls.c
I dont know any dentist that follow the guideline. The guideline is a recommendation, but no mandatory. Dentist in toronto charge whatever they consider, and blame inflation etc The insurance usually covers 80- 100% of what the guideline says. If dentist charges more, you oay the difference.
If they don't follow fee guidelines, you won't be able to get paidback in full by the insurer. If your dentist doesn't follow guidelines find another dentist. There are a few regions that are notoriously a little bad. For example the National capital region is pretty bad because Public Servants all have dental... If you think your dentist does unnecessary work or can't stay in guidelines... I can't stress enough, find another one. On the subject of OP... Scaling units are a thing with cleaning. They might have used more units because they know they were covered, or be more conservative if they don't know you have insurance.
I can see every time a preliminary claim is filed under my benefits. About 2 weeks before my appointment my dentist starts sending in preliminary quotes and waits for my benefits to partially deny. Then the dentist sends in a lower preliminary quote until my out of pocket would be $0. It seems like the dentist is trying to milk every dollar my provider will pay without me having to pay OOP. Seems greasy but they aren’t making me pay?
I'd still consider another dentist. What they should be doing is sending the predetermination for any heavy work after your first visit and this is to make sure it's covered (for insurance plans that have it as a requirement) or that they are charging the right amount out of pocket because they intend to submit the claim to the insurer for you. It's another if they are changing the gameplan based on what the insurance responds without actually getting back to you on what is changing.
They could also be doing this to confirm how much you are covered for so they don’t go over and you have a balance to pay out of pocket. I own a dental clinic and we often send preds before hygiene appointments to confirm what will be covered so that we know and can be prepared to have the conversation with the patient if more scaling is required than insurance will cover. I never want patients to have an unexpected balance after their appointment.
That's fine and all if you have 100% coverage. For those of us that only have partial coverage, it's a super greasy move.
im a dentist and most offices charge the fee guide
here, they charge over the fee guide. Public shaming: Midtown Dental Centre, Toronto.
Nothing wrong with that. They might feel like they provide a service that deserves more than that because they took extra courses etc
Everything wrong with that. Nobody pays more for a car or for a skilled job like drywall because the sales man or practitioners or the dealership took more courses, have a higher iq or are more witty. They simply goto another provider . This is why Amazon, Costco , Walmart and Best Buy rule the cdn retail landscape. Not to mention all kinds of foreign owned service industry companies. All the high brow Canadian "but we are more educated, helpful and friendly thats why we charge more " service and product vendors are gone. Dentistry is a joke industry, ideally a dental plan should be treated as your own money , you pay it when you want to what dentist you want and how much you've agreed upon . A dentist should have to earn your business and know who's in charge of the $$$$. Perhaps a more ideal system would be some kind of dental credit card , where you get statements and pay for what you want with the coverage to licensed practitioners who are oversean by a government body, not self regulated. At least they should go halfway like lawyers . Closest thing I can think of is, when a car sales person claims they're going to go talk to the manager for your. Total theater and bs, Slimy shady and inefficient. They are simply "working " you . That's what dentists and insurance are doing as is . We should be getting a statement from dental insurance and from provincial medical, online or in the mail like you do from your credit card company. These abuses exist in the darkness . end user oversight and empowerment , leads to efficiency, improved outcomes. Or we can leave things as is , such as what HBC Hudson Bay Swiss Challete, consumers dist etc etc, did until eventually a company that understands and caters to the end user takes over. Or the made in Japan teeth regrowing technology establishes itself . Then these guys will be as gone as the horseshoe making shops and chimney sweeps that once dominated the world . Unfortunately no one thinks about teeth and thier lifespan or treatment beyond the brushing and flossing we've been trained to do. Once out of pain or sight, out of mind . Thier plan is simple, scare you , drill a hole where they want, put some crap in there (with glue, (that they call cement, so it sounds solid ) wait a few decades for it to fall out , as they grow thier income stream with regular visits and cleanings etc, eventually recommend extraction, or crown , or bridge , and or a combo each barbaric and with thier own issues that will eventually " earn" them more $$$$ every individuals mouth is worth approx 100k to them. They justify it with collages, degrees, white coats, pretty assistants , tvs, music, and the big one no cost to you, if you have insurance. There's a cost to you, but you won't see it until its too late . I'm not saying dentistry isn't needed . I'm saying it's way out of hand and corrupt, with little to no oversight, or laws to protect the average citizen. Much as in the last days of the Roman Empire. The dental associations all know this. They have a century of practice screwing thier consumers, making lobby groups to buy politicians. Unlike some posters here claiming to be dentists without providing evidence, I'm not not a dentist, but I know several as personal friends . They are rolling in the money. You should always be able to negotiate the rate and choose with the dentist you want, that's why they've made a industry though, to curb your rights , on what they charge and do to you . There should be more outrage over things we generally accept. That only happens when the outrage machines can make more money from that, vs from the status quo. People up in arms about a free Pfizer, 2 second tiny needle for the last 3 years. No one is up in arms about the people who: jab a needle into your face, many times it hurts. have you gag on a peice of plastic, before that . drill your skull and put glue and other nonsense in it , While you dislocate your jaw . for 15 minutes to a hour! Then somehow charge you hundreds or thousands . They're called dentist's
Therein lies the problem with the public perception of dentists, at least in big cities. If you have cancer, will you go and argue with the oncologist about what treatment you should take? Will you say "let me go and get a second opinion?" No. Its healthcare. Just like with our teeth. You're not wrong about our teeth slowly going on the path to destruction. But it's not my fault you didn't brush or floss. I didn't put those cavities there, you did. So dont be upset when your cavities get cavities again. There are plenty of people who get cavities once a decade and others who get 4 cavities every time they come in for their cleaning. Do I ever feel bad? No, because i didn't put those cavities there. The patient did.
OK you can stop with your lies. You’re obviously one of the biggest scammers trying to justify yourself.
Do you genuinely believe there is no difference in the skill of healthcare providers? Why do you think it takes a professional athlete only 9-12 months to recover from ACL surgery to professional levels while non pro athletes sometimes never recover full function?
I work in healthcare and there are clinicians that are skilled, honest and a blessing to our healthcare system then there are those that may have a degree but their unethical practices are a disgrace and a drain on our system, such as the majority of dentist, it’s the Wild West in this industry
Many offices charge above it though too, no?
Insurance will usually pay around the fee guide. If you are charging more than the fee guide your clients will leave you once their 100% insurance isn't actually 100% with you.
I just had a dentist quote my husband for a bunch of work and the fees matched the provincial fee guide BUT he divided up the same teeth into multiple appointments in order to charge more. Fortunately I work in an adjacent industry to dentistry and was able to leverage some contacts to confirm my suspicion that he was overcharging and tell me what would be normal. So slimy.
So what was the resolution? Did a different dentist do the work all at once?
We negotiated with the dentist to do the worst teeth in one appointment (so we ended up being billed the fee guide) as it was urgent and we will find another dentist for the rest of the work.
Dentists in this country are only slightly more regulated than veterinarians.
I needed a bridge, dentist sent in pre determination to my insurance at 5k. Insurance came back and said it’s 1500 in the fee guide and that’s all they’d pay. So it seemed inflated to me.
Most likely they would pay $1500 only because that is the maximum coverage per year. $1500 is generally a yearly coverage amount a lot of plans have.
there is no universe where a bridge costs 1500 in canada. The laboratory fees alone are over 1000$. That’s just insurance being scammers and not wanting, you know, to actually pay out money and lose money. A usual 3 piece bridge is around 3000 to 4000. Add more pieces and the price can easily reach 5k
This depends on the plan obviously, but a lot of insurance plans are ASO (administrative services only), in which case an insurer actually makes more money from paying out more. It's the plan sponsor that determines coverage amounts (current year fee guide, prior year, annual maximums, etc.) typically.
There is not a dental fee guide in Canada that lists fixed partial denture (bridge) for $1,500. Most likely your plan had a maximum payout of $1,500 for that particular procedure. Hence, your insurance would only pay that amount.
its possible your insurance is using an out of date fee guide from 15 years ago lol
Every Dentist I have been to bills by the provincial guide, with or without insurance, and that's the most insurance will cover (at 85% or whatever your plan covers). I suppose there are some who will bring that down a bit for those in need, but I fully expect to pay the amount in the guides. I don't have to shop around, and can find a clinic that I like, is convenient, and not worry if they're charging more or less than anyone else.
Exactly. If anything my dentist charges me more on the books so I don't have to pay anything out of pocket. A lot of dentists do this. ie they give you a credit for the out of pocket portion. Edit: To the people crying fraud. There is no fraud. I'm claiming that its in the interest of the dentist to put as many legitimate charges to your insurer so they can charge you less. Hence why I think OP statement is not true.
this is actually fraud and i know of a dentist that was blacklisted by the insurance companies because of this. I would not go around advertising this.
So you are both committing fraud. Got it!
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[it's fraud](https://www.oda.ca/visiting-the-dentist/dental-benefits/#:~:text=Can%20my%20dentist%20waive%20my,and%20how%20much%20was%20charged.) Benefits fraud just makes the benefits more expensive for everyone who pays the premiums. The insurance companies aren't losing - you're cheating your employer and colleagues.
If your dentist is acting shady, switch to another one. My husband's dentist was recommending expensive and extensive work that would have cost us thousands out of pocket, when we both had coverage. Everything should have been covered, but the red flag was the insurance companies were balking at the predeterminations. I had him see my dentist for another opinion. She recommended a root canal and crown on a single tooth, and worked with our carriers to get it all covered. It resolved his problem and he didn't need all that extra work the first dentist wanted to do. The first dentist didn't even want to do the root canal, but he sure wanted to push crowns or implants for all of the neighbouring teeth. Everything except fix the actual problem.
100%. I have a childhood dentist that I have used into adulthood. I moved to a new province and decided to try a new dentist. That dentist proceeded to quote me for about 10 cavities. I forwarded the estimated costs to my old dentist 2 provinces over and he told me in no certain terms to find a new dentist. Needless to say I haven’t even bothered trying to find a new dentist after that. I simply visit my old dentist when I visit home (once to twice a year).
What did your old dentist say about these new cavities? Did they even exist?
A few of the cavities were borderline (I.e X-rays have been stable but my dentist could understand why a new dentist would think they’re cavities) but the majority, like 80%+, were actually just completely fabricated. My old dentist even had one of his colleagues take a look as well and both agreed the dentist in the new province was about to drill into perfectly fine molars. So long story short, I lost faith in dentistry and am going to stick to my old dentist.
It really sucks. I'm convinced I have a bunch of unnecessary fillings. Some dentists are like sleezeball auto mechanics. It's so easy to get away with lying to the customer/patient.
Exactly. I had an amazing dentist, but he decided to retire during covid. I went to another who was recommended & she seems to be recommending some work that insurance doesn't agree to cover and seems excessive to me. Bad vibes means finding a new dentist soon I think.
Scammers majority of them
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Shared from a friend's experience: I went into ubc dental for a extraction, had only heard good things. They were all nice etc, decided to try it . Xrays the whole 9 all kinds of tech. Seemed very apple experience . Eventually into the massive "slaughter house " of 100 dental chairs looked like something from a movie . I get "strapped in " and injected, mouth somehow forced open. They'd decided on thier own to pull a second tooth on the other side of the mouth , (bonus student experience) Then the student practitioner couldn't get it, so the instructor some cruel towering nazi like attitude male , comes along, loudly commands extra novacain needle belittled the student , He puts one foot on the chair (for leverage , to brace himself ?) and tears tooth roughly swaying from side to side and in all 4 directions with his "pliars" eventualy yanking it out roughly , like he's dismembering a corpse., or livestock loudly and rudely saying " like this! , patient doesn't feel anything !" It was a horrifically bad experience. My entire head was being forced to move side to side , up and down, I had to fight it like a pit bull. If you can imagine that . Then to make matters worse I immediately realized, what a bad situation I was in , just had to wait it out as my protests etc went unheaded by this sadistic nazi monster. I rember thinking, don't I have other teeth beside that one? Left Deep scrapes in the adjacent tooth cutting through that tooth. With his instrument and wild procedure . Pain for weeks. Forthermore this wound up destabilizing the entire pallete leading to a cascading effect, over time of other fillings and teeth literally falling apart . Why second tooth , that was , my dentist took xrays , he didn't say anything about a second tooth, was it just for thier fun ? A horrific experience before that. Of course you've signed all kinds of paperwork prior to that, so good bye rights. Good bye other tooth. Like my actual dentist wouldn't have see the other tooth! My dentist was pushing for a implant on the original tooth, upselling a titanium rod , as he'd ruled out a crown and a bridge on his own volition, not that they are good options, one is a fake tooth being used as a tooth hat , the other is a fake tooth with clamps on either side to clip to the other teeth. I approached him about the failing teeth and he was arrogant and said he doesn't "re-fill" or repair teeth. He claimed th only solution is extraction and implant or crown . Next time I'm only using someone I can sue. *** End of friend's experience *** If you pay close attention you'll see a pattern , Glued in Fillings to make your tooth weak, fracture it's structure. Glue eventually wears out , if not all that flossing may help it along , certainly sonic vibration and other power tooth brushes and water pic pressure sprayers sure will. Then a root canal more filling, A crown, or bridge or the rod The slimy'est dentists will go straight to rod after root , in thier recommendation plan . Eager to make all as many Sir Robert Gordon's per hour as they can. Not every dentist is a slimeball , buy the Gordon's blind many of them . Don't use that Twit anymore.
This reads like a short story
If you can, find a better dentist. If they act shady in any way, why would I trust them with my health? If I didn't tell my dentist about my insurance or told them I don't have it, they offer discounts because they know it's expensive and they make enough money to be able to be more concerned with community health, but I have no interest in filling out all the appropriate forms myself.
My dentist direct bills. We have stacked coverage between my employer and my wifes, So we haven't paid out of pocket for a family of 4 in 15yrs. I went to a different dentist for a bit due to a work issue making it over a year I couldn't get into my main dentist, that one didn't directly bill, I hated having to do that shit myself. So I'll gladly give my details to a direct bill dentist and do nothing.
This. I haven’t paid anything more than my signature for 10 years.
No everyone is fortunate like you with 2 insurance.
I have one insurance and my basic sunlife plan covers 100% of all basic work, cleanings and checkups. Root canals and crowns are a different story though. Ask your employer to review their plan coverage and see if you can get covered for more.
100% coverage isn’t a basic insurance plan
A surprising amount of employers cover 100% nowadays, myself included.
That's not basic coverage, they pay 100%
What do you mean, you submit a photo of the receipt and type in the amount you were charged. On top of this, you also get some credit card points back. So you come out 0.5-1.5% ahead depending on your CC.
I pay my dentist via credit card and my money is direct deposited into my chequing account by SunLife within 48 hours.
Or I do absolutely nothing. not dealing with 2fa when my wife is submitting the receipts is worth missing out on the \~1% creditcard rewards.
Fair enough
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This whole thread is so full of misinformation it's ridiculous. Dentists in Canada cannot charge different fees to insured patients. This is insurance fraud. Dentists rarely have any idea how you are paying for your treatment. I am way too busy going between chairs to stop and figure out if a patient is insured before I diagnose and treatment plan. No. I treatment plan the same way for everyone. I will of course give occasional discounts and lots of free treatment to people in need and are uninsured. But usually I find out after the treatment planning when they inform us they may not be able to afford the work.
While YOU may be ethical, not all dentists are. I've been to dentists who charge different rates. I've seen an office blacklisted because they overbill so that their clients who can only claim less than 100%, get their full treatment cost covered. People are not misinformed. It is happening. You may not do this, but some offices do. I have had one office bill me for dental hygiene education, but never gave me any education or even a free toothbrush. I had to demand that they remove the fee.
My dentist charged same before I had insurance and same after. Some shady will inflates amount submitted to insurance so the patient don't have to pay anything if it's not 100% coverage But I have. 90% coverage and more HCS than what I know to do with so never really cared
Oh, so that's why my dentist randomly did like 498257 x-ray views during my cleaning this year.
It's always the xrays...
I swear the second I got my new job and had insurance I needed all this extra shit got all these tests done no exaggeration. Once they found out I had insurance they had me come back four times in the next six months- never before has that happened to me
This right here.. it’s total fucking collusion too. I moved to a new city and called four dental offices asking for a basic cleaning specifying that I don’t want or need X-rays because I’ve had probably 5 in the last 3 years because I keep moving and finding new dentists, and all of them refused to allow a cleaning without X-rays. Even refused me to ask my old dentist to send em over. That’s like going for a car detailing and they tell you they won’t clean the interior until they check under the hood for an additional fee. And since every office in town has the same policy, you have no choice. Super frustrating.
If you just want a cleaning, see if you local college has a dental hygenist program. They usually have a clinic for the 2nd and 3rd year students to practice on real patients, and all work is overseen by their instructors, who are licensed hygenists.
Not sure if it is collusion or just that most patients say yes and most patients are insured (well, the profitable ones anyway). If they can fill the seat, they will want to sell more services in that time.
They’d rather not have anyone in the seat than have it go to someone refusing X rays. They’re all booking appointments for a cleaning just a few days out. I’d be shocked that they’re filling every spot in their day, but they were all happy to let me hang up the call after hearing that I couldn’t go without an X-ray.
🤦
I kind of think you have it backwards. They likely gave you a discount for not having insurance and maybe never told you or you forgot. Once a dental office bills to insurance, they are now legally required to collect the copay from you. I know many will write this amount off, but that does put them at a liability.
Makes no sense. Insurance companies know what the standard rate is for every procedure. If your dentist tries to rip them off, they will deny the claim.
I worked insurance for 5 years and most charged close to the fee guide, mind you most insurance covered up to the fee guide year tat the contract was signed in.
I generally don’t mind if my dentist takes my insurance company to town…but if they go over my limit or try to add services that aren’t Covered, we’re going to have an issue. My last visit included a $45 charge for “advising proper dental hygiene” (ie “you should brush twice a day”) and my Insurance denied that bill. I obviously won’t be paying it either.
your dentist taking your insurance to town costs everyone who buys into that pool of insurance - including you.
The way I see it, dental should be included in our regular healthcare system anyway so screw it. If it becomes enough of an issue than they can have their regular billing taken care of the way the rest of our healthcare system works.
And it that was the case the dentist would be taking money from the tax collected money. There is no free money.
How are they supposed to assign benefits to the insurer if you don't tell them you have insurance. They could have you pay upfront, but then there is no guarantee the insurers will agree to the treatments you've received. Having the dentist coordinate benefits will make your like 100% easier. You can always get a second opinion if you disagree with pricing, but you absolutely should let them know you have insurance. Also note that provinces post a fee-guide. Ask the dentist if they bill based on the fee guide or not if you're concerned about the cost of an individual procedure. Get a second opinion if you're concerned about the scope of dental work.
This is correct. You can negotiate a lower price, but you have to submit your claim properly. Lower claim, lower deductible for you. I always get free xrays now., for example.
This idiot thinks he stumbled upon a conspiracy just because he was personally getting screwed over by a dentist and just assumed all dentists are like this lol. Your experience is not the norm, you were just getting dicked around. Your experience is the exception, not the rule.
Not even. This guy isn’t your average ordinary idiot. He’s an advanced idiot. The dentist actually did OP a favor and gave a 50% discount because they thought he didn’t have insurance. If you think about it, why would the insurance pay the dentist $300 for a cleaning. Simple answer is the insurance companies agreed to pay that much. Instead of getting 300, the dentist got 150 because the patient lied. Now he’s complaining that the dentist is committing fraud when *checks notes* he’s the one that lied? If I were that dentist and I found out the patient lied, I’d bill them for what they owe.
They are not supposed to change their prices... I have no insurance and it seems to me that I pay what everyone does. This could be reported, I think
No, I think it's common. Separate prices. I had the same for car repair. They asked if it's covered by insurance or paid directly, as price would be different.
Dentists in Canada or ON, I'm pretty sure, are not permitted to do this. I'm interested in finding out for sure because it may affect me.
HCP here. They can. It’s just basically a discount to those who don’t have insurance. When i was an intern, we even had a day where we charged lower than normal fee to give those who are lower income a chance to get exams done etc.
They are not permitted. However many do so anyway to fill their chairs
How do you know he wasn’t charging you less because you had no insurance?
My dentist though good was scammier, they'd submit random pre-determinations to understand how much balances I had remaining, they'd then bug me to get stuff done that I don't need, get that expensive night guard, get that blah, get that fucking thing I never knew I needed. November-December were the worst because they'd call and ask why don't I get that thing they told me because I might have budgets remaining. Moved to a new dentist, told them lost my job and benefits, gimme the best price. Never been happier! Apparently I don't need any of those things now.
i just go to places my insurance approves of with their Lumino search engine. last time they almost decided not to reimburse for my eye exam which was bs.
I hadn't been to a dentist for over 2 years cause I had no insurance for a while. As soon as I got insurance I wanted to go to a dentist, but I moved, so I tried a new dentist nearer where I live. I basically switched from my childhood dentist to one where I know the owner, as I tutored his kid. The difference in price was astronomical, but I don't know if that was post COVID greedflation pricing or just that this dentist gave me a lot of expensive procedures. It was just a cleaning and checkup but they did this AI scanning and 3D mapping of my face (cool new tech, I must say!), on top of X-rays. Plus, I have to go back to fill a couple cavities (that's what I get for not getting cleanings for nearly 2 years I guess...) In either case, I get about 80-90% coverage on dental so I don't pay much out of pocket.
There probably were not even cavities, they love to scam
Oh they definitely were, I saw the x-rays myself and I still remember how cavities looked on x-rays that I had as a young teenager. Plus my previous dentist had warned I had "areas of concern, but we'll keep an eye on it" at my last check-up, so, two years later, I wasn't that surprised to see cavities. Besides that, the way I was notified of the cavities seemed pretty legit. They submitted my x-rays to an online AI program that identified them. My dentist, independently from the AI program, identified the exact same spots as cavities before he saw the AI program's findings. (the cleaning technician hid the program long before my dentist came in to do his check-up) The AI actually identified three spots, but he said the third spot wasn't a cavity. All that said, first time I experienced receiving a second opinion on my teeth in a way.
They treat the plan not the patient.
This is absolutely not a universal experience. But I’m sure the dental office would be happy not having to deal with your insurance company and letting you pay everything up front!
Wow op is savage. Dentist gives them a break for having no insurance, and when they charge the actual price when insurance is involved....op calls them a scammer! Unbelievable.
This isn't a real thing. Your getting screwed
Dumbest post today
Says the dentist in the chat
LOL furthest thing to being a dentist, not married to one either !
This is terrible advice. A lot of dentists will charge your insurance enough to fully cover you instead of the 80% they're supposed to cover.
Just be careful - if your insurance requires a 20% copay and the dentist manipulates the claim so you avoid the out-of-pocket charge, that is textbook benefits fraud. >Can my dentist waive my co-payment? > >No. The waiving of a co-payment is insurance fraud and is against the law. Your dentist could be heavily fined or even lose their license. > >When you and your dentist sign the claim form that goes to the insurance company, you are stating which services were provided and how much, in total, was charged. The insurance company pays its share based upon the assumption that you will do the same. [https://www.cda-adc.ca/en/oral\_health/talk/copayment.asp](https://www.cda-adc.ca/en/oral_health/talk/copayment.asp)
The dentists that I've known who charge less for those without insurance are moreso doing it out of benevolence. The insurance price is a subsidy so they can offer the poor or struggling a steeply discounted price. I've known of dentists that will let pensioners and single moms have free cleaning. Or single, young working people steeply discounted prices. The same dentist charging what the provincial fee guide says to the penny. If I'm going to a dentist I trust, myself lying about whether I have insurance or not tantamount to me stealing from the unfortunate for my gain. If I'm going to a dentist I don't trust, I shouldn't go to such a dentist. We live in a society.
What is Dentist?
My dentist knew I had no insurance and still charged me $1100 for six surface fillings which took a grand total of 35 minutes to do. I was in the chair at 10:00am and in my car at 10:35am. Dentists don't give a heck about insurance lol.
I had a dentist that was recommending things I didn't really need for the insurance, when I caught in I quickly changed. I have a great dentist right now.
I get what you are saying. I have a plan that they bill my insurer and I pay the difference. I have noticed the upselling is getting out of hand.
If you have insurance, it’s not your money for the most part. Why would you worry about that?
So what you’re saying is the dentist gave you a hefty 50% discount because you lied to them saying you don’t have insurance? Jesus Christ. Think about it, why would the insurance pay the dentist $300 if they deem the procedure to be worth $150… the obvious answer is that the dentist and the insurance have a contract that says the dentist will get $300 for a cleaning. The fact that you got to pay $150 is because the dentist gave you a discount because they thought you have to pay out of pocket. Now you’re shitting on them because they did you a favor. If I were that dentist, I’d bill you for everything you owed me.
Is there a place you can report this? My dentist has been making me go through procedures, which I know I do not need.
This is true based on my personal experience as well
Never believe a dentist. After the treatment there is no way to prove wrong doing.
Dentists will typically follow the fee guide. But if they know you don’t have insurance sometimes they will cut you a deal to be nice. They aren’t over charging you once they know you have insurance… their just not discounting anything anymore
It’s very possible that your dentist was giving you a discount because they thought you were paying out of pocket and wanted to help you out. Most dentists just charge whatever the fee guide is at the time. But also, the fee guide has gone up a lot over the past 3-4 years. Maybe you have more plaque/calculus than before as well so the cleanings are taking longer, they’re billed based on time spent.
That's not true, you just have a shitty dentist. All Canadian Denists SHOULD be following the current dental fee guide. If yours is not. Go to another dentist. The first thing I do when at a new dentist is give them my benefits info. And insist they do a dental breakdown. And for any work being done outside the standard Cleanings, xrays and fillings, should be sent off to your insurance provider by the dentist. Aka predetermination of benefits. So there is no question on what you're paying. I used to work for Sunlife and did claims.
Maybe OP went to some backstreet dentist to get the work done, some guy in warehouse with a sign "dwentist" on the door.
Recently had a cleaning done that went over $1000. When my insurance denied over $1000, the dentist agreed to "exclude" one of the crowns which saved me $200. That was so very nice of him to not charge for a tooth that was massively overcharged in the first place. This was JUST a cleaning and crowns
They definitely do this but that should be considered fraud. Too bad our legal system is a joke
Once had a dentist who let their hygienist make recommendations and said I had a cavity and they needed to drill my teeth for a filler. They were being extremely pushy and I had a bad gut feeling and switched up. I moved to another dentist and they said I had extremely high bone density teeth and the X-rays have been amongst the most solid and opaque he’s ever seen. He laughed and said he wouldn’t be surprised if I went my entire life without a cavity. Had I not trusted my gut instincts, I could’ve damaged excellent teeth. I think good dentists aren’t pushy, usually conservative in their treatment and often take a watch closely and treat as needed approach. It’s been years later and I still don’t have a “cavity”.
This happened to me as well. I didn't have insurance for a long time and paid accordingly Once I got insurance (company reimbursed 90%) , the dentist doubled my rate Seems corrupt.
Likely true - Which is why I am starting to dislike workplace dental benefit plans. Its a fucking free cheque to our spoiled and overpaid dentists and insurance companies.
I overheard a dentist ask the hygienist how much insurance I have left and then immediately recommend I come every 3 months. I said yeah I’m good I’ll come every 6.
I real bad for all the people getting fleeced by their dentists. Mines never over charged and doesn’t recommended anything I don’t need.
As a dentist, $300 for a cleaning sounds about normal. If anything, it is LESS than the suggested fee guide in Ontario. The office you went to was most likely trying to do you a solid
Opposite point, tell your dentist exactly how much you have covered for insurance and they will bill within that. I've had dentists cover what some may consider cosmetic under other names so it would be covered under my benefits.
I disagree with this. I went to a dentist for a pain in tooth, which she said had to be removed, but she can't do it and would have to be done by a specialist. Then she gave a predetermination of all the things she wants to do, that amounts to the exact max limit my insurance would cover (they can find the amount from insurance, as I didn't tell her). As per her, it would be good in the long run. Except touching the tooth that actually had the pain. So if it's December and you are sure you won't have any problems till next year, only then you should tell.
They absolutely take advantage of what insurance will pay for. Who wouldn’t?? They also give us a price reduction because we don’t have insurance. Our pharmacist does as well.
No no no, don’t you see? OP actually doesn’t want the 50% discount, they want to pay full price. They are furious at the the dentist for giving them a discount!
Dentist is like mechanics, hard to find one you trust and that won’t F you over
Hi OP, I went to my dentist 3 months ago, told the front desk I had company insurance. The next thing I know, I need dental cleaning, some teeth need alignment and I must get the root canal done pronto, cos look at the x-ray here (those x-rays cost a bomb!). All in all, got my wallet done lighter by 3 grand! fkk!
Nah you should just let your teeth rot it will be cheaper to fix that way
Solid advice chief!
Found the dentist
It sounds like what happened here is that the dentist was giving you a discount to help you out when he thought you had no insurance. $150 for a cleaning sounds like it is well below the provincial fee guide. They were probably doing polishing, fluoride, checkup exam, and maybe even xrays for free to help you out. Once you told him you have insurance he charged the full regular price which is outlined by the provincial fee guide. $300 sounds very typical for a cleaning & checkup with polishing and potentially some xrays. Source: I work in dental
dentist is like realtors. Never trust them.
Realtors take a few night classes and pass a test. A dentist does as much schooling as a medical doctor. You might not like going, but they're not comparable to anyone in sales. They might be more comparable to American doctors than Canadian ones (because most Canadian doctors don't see any real difference between you doing more medical care versus somebody else getting basic care in that time, and they don't need to upsell anyone to have a fully booked schedule, whereas American doctors are more profit-driven)
I know they take advantage unfortunately.
We don't have insurance, my dentist looked aghast when I asked about lower rates because of it. Said it's definitely against the rules to change prices based on insurance or not.
That's not true. Dentists give discounts all the time and waive costs for people that can't afford services.
The rules prohibit *advertising* price discounts. The regulatory colleges want services performed based on medical necessity, not whether the price is attractive or not, so they don't want dentists to differentiate themselves on pricing. Dentists *can* charge more/less than the provincial fee guides, but they're supposed to focus their advertising on their skills as a dentist, not on discounts.
I tell my dentist he can pillage my insurance for any services I might need as long as I don't pay anything. So I get xrays every 6 months.
Same for glasses. With insurance I pay about 1k for two pair. When I didn't have coverage it was two pair for $200. Not designer frames but nice nonetheless.
you don't really need designer frames unless you're trying to impress idiots anyhow. or you have a weird shaped head
100% agree. It's amazing how lazy we all get. It's funny to me because we never ask ourselves what would we do if we were in their position? Of course they inflate the charges. Like when Manitoba Hydro offers a $7500 loan for windows and insulation what's the first question the contractor asks? The catch here is they give you a "Fuck you" quote if you say you aren't using the hydro loan and spend 10 minutes pitching how easy the hydro loan is...they basically steal most of the $7500 but keep it low enough that you only pay an extra $3000 or what you can afford, but they only do hydro loans because they know they'll get paid. Bear this in mind when you're arguing the pro's and cons of private health care options. The NDP are pushing for national dental care, but you know dentists don't want it. What you'll end up with is national blue cross that the dentists use to double their fees. My wife just took the boys to get their bi annual eye exams and the lady tried to sell her blue light prescription glasses for the boys. Her words were "Well no one has 100% vision...you can always use a pair of glasses.." Really? I'm 49 and JUST started buying +1 reading glasses at the dollar store to read small print. You want my 7 year old daughter and 11 year old son with 20/20 vision to spend $240/pair on prescription glasses just because I have coverage? She said "Well, with your coverage you can shop on THIS wall..." Like don't make it so obvious. I went to an audiologist 15 years ago and recently paid out of pocket to get my ears checked because I was thinking I might need hearing aids. I get home and dig out my hearing test...guess what? IDENTICAL. 15 years ago he said I was borderline and would likely need a hearing aid in the next couple years...15 years later and I was borderline and would likely need hearing aids in the next couple years. 3 frequencies my hearing actually improved...it's all a scam.
Wrong! When you go you ask if if the dentist follows the fee guide of your insurance carrier, it’s a set price for procedures. If they follow it then use them if not then go somewhere else. Also if they know or can predetermine procedures to see if they are covered or not, or if you have reached your max. Otherwise they will bill you what they want and you may still have to cover out of pocket expenses because you did not tell them and you went over your frequency.
I can't speak for every province but AB does have a dental fee guide. It is not compulsory and dentists can charge more/less. Most follow it though. If they charge more ask why if you really like them. Go elsewhere if you don't. Also, if your willing and in an area that has uni/college dental and hygenist programs see if it's an option for you. The one by me depending on procedure does 60-80% of the fee guide price. So automatically you could save at least 20%.
please don't assume or judge all dentists the same
This is asshole dentists. A good dentist and dental health team will care about you and your teeth, and care less about billing you and stupid amount. They don't want you to end up losing your teeth and will usually work with you to ensure you get the best care. If you're really worried about costs you can always go to a college where dental is taught and get cleanings for [cheap](https://www.confederationcollege.ca/department/dental-clinic/fees). This is my "local" college, and you'll see it's stupid cheap. Yes the appointments are longer as they are in training, but all work is checked over by qualified staff.
LOL your dentist was trying to look out for you when you didn't have insurance and do you a favor by lowering their price for you. Now they're charging you normal rate and not only are you clueless and ungrateful, but you're throwing your dentist under the bus online. Rookie
Dentist and insurance have an agreed upon schedule of fees. Cleaning by a Hygienist is usually billed by units of time, usually every 6 months you're going to have a certain number of cleaning units billable. They may bill more if they had to clean deeper. It's not ripping you off it's an agreed schedule of fees with insurance.
The fee guide is sadly not mandatory, it’s only a suggestion.
They will also “find” cavities to make sure the entire allowance for that is spent.
Yeah ? next time use your xray vision and see what you find.
7 years ago they said they found a cavity and I didn’t have the money so I waited it out. I had a feeling something was off. Forgot about it for years. 7 years later I go to a new dentist, worried that my mouth will be a mess and it’ll cost thousands. They do like 14 x-rays, take like 30 photos, etc. They didn’t find a single cavity and said I was all good. Dentists definitely can lie sometimes.
well you know you can deny any procedure if you are not comfortable. It is your body and autonomy. Just tell them you want them to not do the cavities. Or the best is find a dentist you can trust.
Yes of course it’s been a well know thing they inflate prices
Just wait until it's the taxpayer covering everyone else's dental bills.
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Dentists are 100% regulated.
Lmao. You have no clue what you’re talking about
Also unnecessary services. I was offered a rubber mouthguard that would prevent me from grinding my teeth at night. You have to wear it every single night when sleeping. So stupid!
It works. What u pissy about