No Gap Policy for Insurance Patients
Dental One aims to provide affordable dentistry for all our patients. We are pleased to provide General dental services for patients with Dental insurance at no out of pocket cost. This means that we will bill your health care provider directly (via HICAPS) and where a full benefit is provided you will not have to pay any additional amount towards your treatment.
- This service is provided towards General Dental services ONLY including but not limited to: Examinations, Cleans and X-rays. Items such as Fillings, Extractions, Crowns, Root Canals, Dentures and Implants are all considered “Major Dental” and will have an out of pocket expense.
- It is your responsibility to confirm whether you have an annual limit, how much is available and whether you will have sufficient funds to carry out your treatment
- If your insurance provider does not provide the full rebate amount for a particular service due to reaching your yearly cap, you will need to pay the difference between the amount they would usually pay, and the amount they did pay.
- If your insurance provider does not provide a rebate on the treatment code you will be required to pay the full amount out of pocket. We will always attempt to prepare a quote prior to any work commencing so you are aware of costs however it is ultimately the responsibility of the patient to ensure they have enough benefit remaining on their policy.
- If a direct claim cannot be made on the day due to a patients insurance being un-financial (not up to date with payments), the card being too damaged to be read, or if the particular health fund is down via our Terminal, we may ask you to pay for the service and then claim back the total amount through your health fund. If the amount paid is higher than the claimed amount, we have a 30 day limit where Dental One will refund you the difference between the amount paid by you and the amount paid by your health insurance.
Mary has an annual limit of $500 for General Dental per calendar year. She comes to Dental One for a routine check-up and clean. The Dentist advises that Mary also needs 4 fillings and prepares a quote via HICAPS. Mary’s insurance will have enough funds to cover most of the treatment but will only cover $60 instead of $100 on the last filling. Mary will need to pay $40 out of pocket for the final filling. Mary will not have to pay any out of pocket on the other treatment.